Preliminary Analysis of Changes in Depression and Pain Interference in Persons with Spinal Cord Injury and Chronic Pain Participating in a 10-week Non-pharmacologic Pain Management Program

A single-blind randomized clinical trial with assessment at baseline (T1), end-of-program (T2); and 4 weeks post-program (T3) was performed to determine the effect of a 10-week pain management program on pain interference and depression in individuals with spinal cord injury (SCI) and chronic pain.   Participants wereadult wheelchair users with SCI and chronic pain (≥4/10) with: no other pain-causing or exercise-limiting conditions; no recent arm surgery or rotator cuff tear; ability to actively reach shoulder-height, use a phone; and English proficiency. After T1, participants were randomized to intervention (INT) or control (CON) groups. INT completed a 10-week program; CON received no intervention. Both groups were assessed at T2 and T3.  Interventions includeda 10-week pain management program for INT participants, including 19 sessions of education and practice of active pain management tools.PHQ-9 assessed depression and ISCI-Pain-BDS measured pain interference. Group differences (INT vs. CON) over T1, T2 and T3 were preliminarily analyzed.  Twenty-two participants  completed the study (15=INT, 7=CON). Pain interference reduced in both groups at T2, with further reduction in the INT group at T3 vs the CON group. No significant interaction or main effects were found. Pain interference significantly decreased for all participants at T2 (4.8) compared to T1 (5.6) (p=0.026). There was no significant main or interaction effect of group or time on depression (INT: (T1=5.1 , T2=4.5, T3=4.5) and CON (T1=5.3, T2=3.8, T3=5.5). Across all participants, changes in depression and interference from T1 to T3 were significantly correlated (p=.03, r=0.5).  In conclusion, a 10-week nonpharmacologic pain management program led to lasting reductions in pain interference over 14 weeks, though not statistically different from controls. Greater depression improvement from T1 to T3 was significantly associated with reduced interference, despite mild improvements in both groups, suggesting the program may influence the relationship between interference and depression.