Spinal Cord Series and Cases (2017) 3:17083
Neuropathic pain in a rehabilitation setting after spinal cord injury:
an interpretative phenomenological analysis of inpatients’
Jasmine Heath Hearn
Katherine Anne Finlay
Philip A. Fine
Received: 25 November 2016 / Revised: 11 October 2017 / Accepted: 17 October 2017
© International Spinal Cord Society 2017
Study design Qualitative, semi-structured interviews.
Objectives Neuropathic pain (NP) can be psychologically and physically debilitating, and is present in approximately half of
the spinal cord injured (SCI) population. However, under half of those with NP are adherent to pain medication. Under-
standing the impact of NP during rehabilitation is required to reduce long-term impact and to promote adherence to
medication and psychoeducation recommendations.
Setting United Kingdom.
Methods Five males and three females with SCI and chronic NP, resident in rehabilitation wards at a specialist SCI center in
the United Kingdom, took part. Semi-structured interviews were conducted with participants less than 15 months post-SCI
(mean = 8.4 months). Verbatim transcripts were subject to interpretative phenomenological analysis (IPA).
Results Three super-ordinate themes were identiﬁed, mediating pain and adherence: (1) the dichotomy of safety perceptions;
(2) adherence despite adversity; and (3) ﬁghting the future. Analyses suggest that experience of the rehabilitation setting and
responsiveness of care shapes early distress. Attitudes to medication and psychosocial adjustment are relevant to developing
expectations about pain management.
Conclusions Enhancing self-efﬁcacy, feelings of safety in hospital, and encouraging the adoption of adaptive coping
strategies may enhance psychosocial and pain-related outcomes, and improve adherence to medication. Encouraging
adaptive responses to, and interpretation of, pain, through the use of interventions such as coping effectiveness training,
targeted cognitive behavioral pain management, and acceptance-based interventions such as mindfulness, is recommended in
order to reduce long-term reliance on medication.
Over 60% of individuals with spinal cord injury (SCI) are
affected by chronic pain [1, 2], a signiﬁcant problem that
should be addressed from its onset to facilitate early
adjustment to both pain and SCI. People with neuropathic
pain (NP) often report difﬁculty managing it, describing
unique sensory qualities of pain, including burning, electric,
and crushing sensations , and these can be potentially
distressing in nature. NP typically ﬂuctuates in severity,
worsening over time , with between 34 and 41% of the
SCI population with NP in the early stages of rehabilitation
living with it at 5 years post-injury , signifying a
potential correlation and the need for early intervention/
Despite its prominence, and the limited effectiveness of
medication , common practice ﬁrst-line treatment for NP
remains targeted pharmacological pain management .
Such approaches are essential, given the structural and
biochemical changes associated with nerve damage after
SCI . However, poor adherence is common in pain
populations ; fewer than half (43%) of people with NP
were compliant with their drug regimes in one study .
Adherence is related directly to the participants’ beliefs
* Jasmine Heath Hearn
The University of Buckingham Medical School, Hunter Street,
Buckingham MK18 1EG, UK
The Department of Psychology, The University of Buckingham,
Hunter Street, Buckingham MK18 1EG, UK
The National Spinal Injuries Centre, Stoke Mandeville Hospital,
Aylesbury HP21 8AL, UK