Healthcare providers perspective of chronic pain management in persons with traumatic spinal cord injury accessing the public system in a region of South Africa.

ABSTRACT

PURPOSE: Persons with traumatic spinal cord injury (PWTSCI) have expressed a lack of education from healthcare providers and poor shared-decision making between providers and clients. The aim was to explore the healthcare providers' perspective on factors influencing the optimal management of chronic pain. METHODS: Healthcare providers were recruited from two institutions at tertiary healthcare level. Interviews explored current chronic pain management practices, influencing factors and recommendations for improvement. Data saturation occurred after interviewing 11 participants. Thematic analysis was used through a socio-ecological model. RESULTS: The challenges to optimal pain management include appropriate assessment and management of psychological health (intrapersonal level), substance abuse amongst patients (intrapersonal level), access to medication for providers and lack of knowledge by providers (interpersonal and organizational level). To improve chronic pain management, an interdisciplinary team approach should be operationalized at policy and organizational level, monitoring and adjustment of interventions should take place (interpersonal), and family members/caregivers should be involved in the planning and monitoring (interpersonal). CONCLUSION: Factors, at the interpersonal, intrapersonal, organizational and policy levels, influence optimal chronic pain management in the traumatic spinal cord injury (TSCI) population. To mitigate challenges, guidelines for chronic pain management should be developed, particularly for low-resourced developing countries.

Traumatic spinal cord injury chronic painChallenges to effective chronic pain management are multifold and include intrapersonal, interpersonal, organizational, and policy factors, in South Africa.The lack of guidance frameworks and contextualized guidelines inhibits optimal chronic pain management.Holistic assessment and management of chronic pain should be prioritized in the acute care setting in order to follow through to the rehabilitation and primary care settings.Mental health and its impact on chronic pain should be assessed and managed at all levels of care.