Background: Chronic neuropathic pain is one of the most difficult problems to manage after spinal cord injury (SCI). Pain coping and pain cognitions are known to be associated with the patient’s experience of neuropathic pain, but they have not been studied in the context of a cognitive behavioral treatment program for coping with neuropathic pain after SCI. Objective: To explore associations of pain coping strategies and cognitions with pain intensity and pain-related disability and changes in pain coping strategies and cognitions with changes in pain intensity and pain-related disability. Methods: Forty-seven persons who participated in the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial completed questionnaires before the intervention (baseline) and 3 months after of the intervention (follow-up). Results: Compared to baseline, participants showed more favorable scores on 2 pain coping scales (Pain Transformation and Worrying), the subtotal score Active Coping, and 3 pain cognitions scales (Catastrophizing, Optimism, and Reliance on Health Care) at follow-up. Baseline Reliance on Health Care was associated with change in pain intensity and pain-related disability. Change in Catastrophizing and change in Restriction cognitions were associated with change in pain-related disability. Conclusions: Our findings suggest that modifying pain coping strategies and cognitions by a cognitive behavioral intervention for chronic neuropathic pain after SCI may have some beneficial effects on pain intensity and pain-related disability. Further research should show how dysfunctional pain coping strategies and cognitions can be most effectively modified.

Siddall PJ, McClelland JM, Rutkowski SB, Cousins MJ. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain. 2003;103(3):249–257.
,
A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury
,
Pain.
, vol.
103
(pg.
249
-
257
)
Siddall PJ, Taylor DA, McClelland JM, Rutkowski SB, Cousins MJ. Pain report and the relationship of pain to physical factors in the first 6 months following spinal cord injury. Pain. 1999;81(1-2):187–197.
,
Pain report and the relationship of pain to physical factors in the first 6 months following spinal cord injury
,
Pain.
, vol.
81
(pg.
187
-
197
)
Siddall PJ. Management of neuropathic pain following spinal cord injury: Now and in the future. Spinal Cord. 2009;47(5):352–359.
,
Management of neuropathic pain following spinal cord injury: Now and in the future
,
Spinal Cord.
, vol.
47
(pg.
352
-
359
)
Widerström-Noga EG, Felipe-Cuervo E, Broton JG, Duncan RC, Yezierski RP. Perceived difficulty in dealing with consequences of spinal cord injury. Arch Phys Med Rehabil. 1999;80(5):580–586.
,
Perceived difficulty in dealing with consequences of spinal cord injury
,
Arch Phys Med Rehabil.
, vol.
80
(pg.
580
-
586
)
Jensen MP, Hoffman AJ, Cardenas DD. Chronic pain in individuals with spinal cord injury: A survey and longitudinal study. Spinal Cord. 2005;43(12):704–712.
,
Chronic pain in individuals with spinal cord injury: A survey and longitudinal study
,
Spinal Cord.
, vol.
43
(pg.
704
-
712
)
Siddall PJ, Loeser JD. Pain following spinal cord injury. Spinal Cord. 2001;39(2):63–73.
,
Pain following spinal cord injury
,
Spinal Cord.
, vol.
39
(pg.
63
-
73
)
Wollaars MM, Post MW, van Asbeck FW, Brand N. Spinal cord injury pain: The influence of psychologic factors and impact on quality of life. Clin J Pain. 2007;23(5):383–391.
,
Spinal cord injury pain: The influence of psychologic factors and impact on quality of life
,
Clin J Pain.
, vol.
23
(pg.
383
-
391
)
Widerström-Noga EG, Felix ER, Cruz-Almeida Y, Turk DC. Psychosocial subgroups in persons with spinal cord injuries and chronic pain. Arch Phys Med Rehabil. 2007;88(12):1628–1635.
,
Psychosocial subgroups in persons with spinal cord injuries and chronic pain
,
Arch Phys Med Rehabil.
, vol.
88
(pg.
1628
-
1635
)
Jensen MP, Moore MR, Bockow TB, Ehde DM, Engel JM. Psychosocial factors and adjustment to chronic pain in persons with physical disabilities: A systematic review. Arch Phys Med Rehabil. 2011;92(1):146–160.
,
Psychosocial factors and adjustment to chronic pain in persons with physical disabilities: A systematic review
,
Arch Phys Med Rehabil.
, vol.
92
(pg.
146
-
160
)
Haythornthwaite JA, Benrud-Larson LM. Psychological aspects of neuropathic pain. Clin J Pain. 2000;16(2 Suppl):S101–5.
,
Psychological aspects of neuropathic pain
,
Clin J Pain.
, vol.
16
(pg.
S101
-
5
)
Turk DC, Okifuji A. Psychological factors in chronic pain: Evolution and revolution. J Consult Clin Psychol. 2002;70(3):678–690.
,
Psychological factors in chronic pain: Evolution and revolution
,
J Consult Clin Psychol.
, vol.
70
(pg.
678
-
690
)
Turner JA, Jensen MP, Warms CA, Cardenas DD. Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury. Pain. 2002;98(1-2):127–134.
,
Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury
,
Pain.
, vol.
98
(pg.
127
-
134
)
Giardino ND, Jensen MP, Turner JA, Ehde DM, Cardenas DD. Social environment moderates the association between catastrophizing and pain among persons with a spinal cord injury. Pain. 2003;106(1- 2):19–25.
,
Social environment moderates the association between catastrophizing and pain among persons with a spinal cord injury
,
Pain.
, vol.
106
(pg.
19
-
25
)
Molton IR, Stoelb BL, Jensen MP, Ehde DM, Raichle KA, Cardenas DD. Psychosocial factors and adjustment to chronic pain in spinal cord injury: Replication and cross-validation. J Rehabil Res Dev. 2009;46(1):31–42.
,
Psychosocial factors and adjustment to chronic pain in spinal cord injury: Replication and cross-validation
,
J Rehabil Res Dev.
, vol.
46
(pg.
31
-
42
)
Raichle KA, Hanley M, Jensen MP, Cardenas DD. Cognitions, coping, and social environment predict adjustment to pain in spinal cord injury. J Pain. 2007;8(9):718–729.
,
Cognitions, coping, and social environment predict adjustment to pain in spinal cord injury
,
J Pain.
, vol.
8
(pg.
718
-
729
)
Ehde DM, Jensen MP. Psychological treatments for pain management in persons with spinal cord injury: Cognitive therapy and self-hypnosis training. Top Spinal Cord Inj Rehabil. 2007;13(2):72–80.
,
Psychological treatments for pain management in persons with spinal cord injury: Cognitive therapy and self-hypnosis training
,
Top Spinal Cord Inj Rehabil.
, vol.
13
(pg.
72
-
80
)
Turner JA, Holtzman S, Mancl L. Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain. Pain. 2007;127(3):276–286.
,
Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain
,
Pain.
, vol.
127
(pg.
276
-
286
)
Kennedy P, Duff J, Evans M, Beedie A. Coping effectiveness training reduces depression and anxiety following traumatic spinal cord injuries. Br J Clin Psychol. 2003;42(Pt 1):41–52.
,
Coping effectiveness training reduces depression and anxiety following traumatic spinal cord injuries
,
Br J Clin Psychol.
, vol.
42
(pg.
41
-
52
)
Nicholson Perry K, Nicholas MK, Middleton JW. Comparison of a pain management program with usual care in a pain management center for people with spinal cord injury-related chronic pain. Clin J Pain. 2010;26(3):206–216.
,
Comparison of a pain management program with usual care in a pain management center for people with spinal cord injury-related chronic pain
,
Clin J Pain.
, vol.
26
(pg.
206
-
216
)
Norrbrink Budh C, Kowalski J, Lundeberg T. A comprehensive pain management programme comprising educational, cognitive and behavioural interventions for neuropathic pain following spinal cord injury. J Rehabil Med. 2006;38(3):172–180.
,
A comprehensive pain management programme comprising educational, cognitive and behavioural interventions for neuropathic pain following spinal cord injury
,
J Rehabil Med.
, vol.
38
(pg.
172
-
180
)
Jensen MP, Turner JA, Romano JM. Changes after multidisciplinary pain treatment in patient pain beliefs and coping are associated with concurrent changes in patient functioning. Pain. 2007;131(1-2):38–47.
,
Changes after multidisciplinary pain treatment in patient pain beliefs and coping are associated with concurrent changes in patient functioning
,
Pain.
, vol.
131
(pg.
38
-
47
)
Heutink M, Post MW, Luthart P, Pfennings LE, Dijkstra CA, Lindeman E. A multidisciplinary cognitive behavioural programme for coping with chronic neuropathic pain following spinal cord injury: The protocol of the CONECSI trial. BMC Neurol. 2010;10:96.
,
A multidisciplinary cognitive behavioural programme for coping with chronic neuropathic pain following spinal cord injury: The protocol of the CONECSI trial
,
BMC Neurol.
, vol.
10
Heutink M, Post MW, Bongers-Janssen HM, et al. The CONECSI trial: Results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury. Pain. 2012;153(1):120–128.
,
The CONECSI trial: Results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury
,
Pain.
, vol.
153
(pg.
120
-
128
)
Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50(2):133–149.
,
Grading the severity of chronic pain
,
Pain.
, vol.
50
(pg.
133
-
149
)
Engel GL. The need for a new medical model: A challenge for biomedicine. Science. 1977;196(4286):129–136.
,
The need for a new medical model: A challenge for biomedicine
,
Science.
, vol.
196
(pg.
129
-
136
)
Ellis A. Rational psychotherapy and individual psychology. J Individ Psychol. 1957;13:38–44.
,
Rational psychotherapy and individual psychology
,
J Individ Psychol.
, vol.
13
(pg.
38
-
44
)
Bouhassira D, Attal N, Alchaar H, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114(1-2):29–36.
,
Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4)
,
Pain.
, vol.
114
(pg.
29
-
36
)
Kraaimaat FW, Evers AW. Pain-coping strategies in chronic pain patients: Psychometric characteristics of the pain-coping inventory (PCI). Int J Behav Med. 2003;10(4):343–363.
,
Pain-coping strategies in chronic pain patients: Psychometric characteristics of the pain-coping inventory (PCI)
,
Int J Behav Med.
, vol.
10
(pg.
343
-
363
)
Kraaimaat FW, Bakker A, Evers AWM. Pijncopingstrategieën bij chronische pijnpatiënten: De ontwikkeling van de pijn-coping-inventarisatielijst (PCI) [Pain coping strategies in chronic pain patients: The development of the pain coping inventory (PCI)]. Gedragstherapie. 1997;3:185–201.
,
Pijncopingstrategieën bij chronische pijnpatiënten: De ontwikkeling van de pijn-coping-inventarisatielijst (PCI) [Pain coping strategies in chronic pain patients: The development of the pain coping inventory (PCI)]
,
Gedragstherapie.
, vol.
3
(pg.
185
-
201
)
Van Breukelen GJ, Vlaeyen JW. Norming clinical questionnaires with multiple regression: The pain cognition list. Psychol Assess. 2005;17(3):336–344.
,
Norming clinical questionnaires with multiple regression: The pain cognition list
,
Psychol Assess.
, vol.
17
(pg.
336
-
344
)
Vlaeyen JWS, van Breukelen G, Nooyen-Haazen IWCJ, Stomp-van den Berg SGM, Kole-Snijders AMJ. Meetinstrumenten chronische pijn: Deel 4. pijn cognitie lijst-2003. Handleiding [Measuring Instruments for Chronic Pain: Part 4. Pain Cognition List-2003. Manual]. Maastricht, The Netherlands: Pijn Kennis Centrum [Pain Expertise Centre]; 2004.
,
Meetinstrumenten chronische pijn: Deel 4. pijn cognitie lijst-2003. Handleiding [Measuring Instruments for Chronic Pain: Part 4. Pain Cognition List-2003. Manual].
Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary rehabilitation for chronic low back pain: Systematic review. BMJ. 2001;322(7301):1511–1516.
,
Multidisciplinary rehabilitation for chronic low back pain: Systematic review
,
BMJ.
, vol.
322
(pg.
1511
-
1516
)
Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. CMAJ. 2001;165(2):174–179.
,
Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes
,
CMAJ.
, vol.
165
(pg.
174
-
179
)
Linde K, Witt CM, Streng A, et al. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain. 2007;128(3):264–271.
,
The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain
,
Pain.
, vol.
128
(pg.
264
-
271
)
Crow R, Gage H, Hampson S, Hart J, Kimber A, Thomas H. The role of expectancies in the placebo effect and their use in the delivery of health care: A systematic review. Health Technol Assess. 1999;3(3):1–96.
,
The role of expectancies in the placebo effect and their use in the delivery of health care: A systematic review
,
Health Technol Assess.
, vol.
3
(pg.
1
-
96
)
Ullrich P, Jensen M, Loeser J, Cardenas D. Catastrophizing mediates associations between pain severity, psychological distress, and functional disability among persons with spinal cord injury. Rehabil Psychol. 2007;52(4):390–398.
,
Catastrophizing mediates associations between pain severity, psychological distress, and functional disability among persons with spinal cord injury
,
Rehabil Psychol.
, vol.
52
(pg.
390
-
398
)
Nicholson Perry K, Nicholas MK, Middleton J. Spinal cord injury-related pain in rehabilitation: A crosssectional study of relationships with cognitions, mood and physical function. Eur J Pain. 2009;13(5):511–517.
,
Spinal cord injury-related pain in rehabilitation: A crosssectional study of relationships with cognitions, mood and physical function
,
Eur J Pain.
, vol.
13
(pg.
511
-
517
)
Nicholson Perry K, Nicholas MK, Middleton J, Siddall P. Psychological characteristics of people with spinal cord injury-related persisting pain referred to a tertiary pain management center. J Rehabil Res Dev. 2009;46(1):57–67.
,
Psychological characteristics of people with spinal cord injury-related persisting pain referred to a tertiary pain management center
,
J Rehabil Res Dev.
, vol.
46
(pg.
57
-
67
)
Hanley MA, Raichle K, Jensen M, Cardenas DD. Pain catastrophizing and beliefs predict changes in pain interference and psychological functioning in persons with spinal cord injury. J Pain. 2008;9(9):863–871.
,
Pain catastrophizing and beliefs predict changes in pain interference and psychological functioning in persons with spinal cord injury
,
J Pain.
, vol.
9
(pg.
863
-
871
)
Summers JD, Rapoff MA, Varghese G, Porter K, Palmer RE. Psychosocial factors in chronic spinal cord injury pain. Pain. 1991;47(2):183–189.
,
Psychosocial factors in chronic spinal cord injury pain
,
Pain.
, vol.
47
(pg.
183
-
189
)
This content is only available as a PDF.