Eva Widerström-Noga

Introduction: Spinal cord injury (SCI) results in several medical consequences. While some of these are immediate, others, like chronic pain, may emerge after weeks or months. Roughly 60% of individuals develop persistent neuropathic pain within the first year after injury. Due to the limited efficacy and negative side-effects of current pharmacological agents, many patients seek non-pharmacological options. Methods: The present mixed-method study explored individual perspectives of 35 participants with neuropathic pain and SCI on a multimodal 12-week pain program including pain education, exercise, and walking illusions. Results: After completion of the program participants reported reduced pain and pain interference, better understanding of pain and pain management, and lower medication use. Other reported benefits included an expanded mindset, useful community and interpersonal connections, positive health impact, increased motivation, and elevated self-image. Negative perceptions included fatigue, short-lasting or minimal effects on pain, and lack of realism of walking illusions. Pain assessment scores supported the overall positive effects on neuropathic pain with significant reductions in neuropathic pain severity, pain interference with activities and mood, and difficulty dealing with pain. These results suggest that a multimodal pain program combining pain education, exercise and walking illusions can reduce neuropathic pain and its impact after SCI.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Black and Hispanic/Latino communities experience disproportionate chronic pain and are underrepresented in pain research. Transcutaneous auricular vagus nerve stimulation (taVNS) and transcranial magnetic stimulation (TMS) are promising tools for pain management. Therefore, it is critical to ensure that research using these tools engages all communities to make research findings more generalizable and reach all who may benefit. Lack of diversity in the research workforce itself is a key barrier to improving Black and Hispanic/Latino representation in pain research, and video-enhanced recruitment and consenting may be a useful tool to better engage Black and Hispanic/Latino communities. Objective: Thus, the primary goal of this project was to use participatory methods to develop informational videos for inclusive brain stimulation research recruitment. Methods: Using community participatory research principles in an iterative process, key stakeholders were engaged in 2 consecutive studies to create and then test informational videos on taVNS and TMS. The key stakeholders included neuromodulation researchers as well as Black English-speaking, Hispanic/Latino Spanish-speaking, and Haitian-Creole speaking people with chronic pain. The first study involved iterative feedback from stakeholders through focus groups and interviews to develop test videos, which were then refined based on community member input. The second study was a pilot randomized controlled trial (RCT) used to assess the impact of these videos on participant expectations for pain relief with taVNS. Results: Twenty-five community members with chronic pain provided input in the development of the videos, which received overwhelmingly positive feedback. Twenty-eight people with chronic neuropathy were enrolled in the RCT, with 24 completing the study. There was no significant difference in expectancy scores ( between those who viewed the videos and those who received traditional brochures (median values of 8.2 for both groups, and 95% confidence intervals for the means of 7.2-8.7 and 6.4-8.7, P=.8). Conclusions: These findings suggest that while the videos may improve engagement, they do not unduly influence expectations, potentially making them valuable tools for improving research participation in non-invasive brain stimulation research. These videos will be freely available to help researchers to engage people from diverse communities. Clinical Trial: ClinicalTrials.gov NCT05896202; https://clinicaltrials.gov/study/NCT05896202?term=marlon%20wong&rank=3

Background: Neuropathic pain is common after spinal cord injury (SCI). Despite the availability of various treatments, many report inadequate pain relief, and various side effects.Objective: The primary purpose of the current study was to explore participants’ perspectives on a brief, four-week virtual pain education program and second to evaluate any effects on pain and psychosocial factors.Methods: This study included 36 participants with SCI who experienced moderate to severe neuropathic pain and explored their perspectives on the pain program using qualitative interviews and evaluated a small set of self-reported pain outcomes.Results: The analysis and coding of the qualitative interview data resulted in two primary overarching themes: Benefits of pain education and Content and delivery of pain education. The Benefits of pain education theme was further analyzed and divided into 6 subthemes: Learning about pain and treatment options in general, Learning from and interacting with peers, Learning about non-pharmacological approaches and ways to self-manage pain, Learning about pathophysiology of pain, Learning about pain medication, and Improving communication about the lived experience with pain. Under the main theme of Content and delivery of Pain Education, there were three subthemes: Positive, No effect or negative, and Change suggestions. Specifically, participants reported having a better understanding about treatment options, how their peers managed their pain, and the underlying causes and types of pain. Participants also perceived that this knowledge would improve their ability to talk to others about their pain. Participants mentioned the topics discussed and the small group interactive settings as positive aspect of the education, although some did not benefit or felt that focusing on pain made pain more obvious to them. The overall benefit was consistent with small but significant improvements in perceived pain interference with daily activities and difficulty in dealing with pain (p < 0.05).Conclusion: Overall, these findings suggest that a brief, virtually administered pain education program in a small group setting may be a positive addition to an interdisciplinary pain program. Future research should continue to develop and individually tailor such programs in this population, as these approaches are low-cost and easily accessible.

Black and Hispanic/Latino communities experience disproportionate chronic pain and are underrepresented in pain research. Transcutaneous auricular vagus nerve stimulation (taVNS) and transcranial magnetic stimulation (TMS) are promising tools for pain management. Therefore, it is critical to ensure that research using these tools engages underrepresented communities to make research findings more generalizable and reach all who may benefit. Lack of diversity in the research workforce itself is a key barrier to improving Black and Hispanic/Latino representation in pain research, and video-enhanced recruitment and consenting may be a useful tool to better engage minoritized communities. Using community participatory research principles in an iterative process, we engaged key stakeholders, including neuromodulation researchers and minoritized community members, to create and test informational videos on taVNS and TMS. These videos were designed for Black English-speaking, Hispanic/Latino Spanish-speaking, and Haitian-Creole speaking people with chronic pain. Study 1 involved iterative feedback from stakeholders to develop test videos, which were then refined based on community member input. Study 2 was a pilot randomized controlled trial assessing the impact of these videos on participant expectations for pain relief with taVNS. Results indicated that the videos were well-received, and there was no significant difference in expectancy scores between those who viewed the videos and those who received traditional brochures. This suggests that while videos may improve engagement, they do not unduly influence expectations, potentially making them valuable tools for improving research participation in underrepresented populations. These videos will be freely available to help researchers to engage people from minority communities. PERSPECTIVE This article presents the process of developing culturally sensitive informational videos on taVNS and TMS, and provides the field with these videos in English, Spanish, and Haitian-Creole language. These videos could potentially help researchers to engage people from minority communities to enhance the diversity and reach of research using noninvasive brain stimulation for pain.

Background: This study aims to identify sociodemographic factors associated with cannabis use for chronic pain management before and after COVID‐19 was declared a pandemic. Furthermore, it seeks to compare cannabis use patterns in adults with and without chronic pain. Methods: We analyzed US‐based responses from the COVID‐19 Cannabis Health Study, a cross‐sectional online survey administered via REDCap between March 2020 and March 2022. All respondents were cannabis consumers in the past year. Cannabis use patterns and chronic pain were self‐reported via the COVID‐19 Cannabis Health Questionnaire. Statistical analysis included Chi‐square tests, Fisher’s exact tests, t ‐tests, and multivariable logistic regression with a two‐tailed alpha of 0.05 for significance. Results: Among 2243 participants, 50.3% consumed cannabis to manage chronic pain. Younger age (< 40 years; aOR: 3.20, 95% CI: 2.59–3.96), Hispanic/Latino ethnicity (aOR: 2.20, 95% CI: 1.56–3.05), and higher income levels (> $100,000 annually; aOR: 1.69, 95% CI: 1.25–2.29) were associated with higher odds of consuming cannabis to manage chronic pain. Participants using cannabis for chronic pain were more likely to use a CBD/THC ratio. The pandemic led to increased dosages and changes in consumption methods: 40.5% increased their cannabis dose, smoking as the primary method declined from 62.2% before the pandemic to 34.5% afterward, while edibles rose from 7.9% to 30.9%, and tinctures from 3.2% to 8.6%. Route changes varied with chronic pain status. Conclusion: There was a shift from smoking to nonsmoking methods to manage chronic pain. Those who were younger and those of Hispanic/Latino ethnicity had higher odds of using cannabis for chronic pain.

Introduction: Spinal cord injury (SCI) often leads to neuropathic pain that negatively affects quality of life. Several qualitative research studies in individuals with SCI who experience neuropathic pain indicate the lack of adequate information about pain. We previously developed an educational resource, the SeePain, based on scientific literature and a series of qualitative interviews of people with SCI, their significant others/family members, and SCI healthcare providers.Methods: However, to quantitatively evaluate the utility of this educational resource in a larger sample, we examined the agreement and usefulness ratings of statements regarding clarity/comprehensibility, content, and format of the SeePain, derived from the thematic analysis of our previous qualitative interviews. Participants completed a survey that provided a digital version of the SeePain and then rated their agreement/usefulness with the statements using numerical rating scales.Results: There were overall high perceived agreement and usefulness ratings regarding the SeePain’s clarity, content, and format. A factor analysis reduced the agreement and usefulness ratings into 4 components (content, clarity, format, and delivery medium). Group comparisons showed that individuals with higher education were more likely to endorse electronic and website formats, and the usefulness of a shorter version of the SeePain; females and younger individuals showed greater endorsement for clarity. Finally, higher pain intensity ratings were associated with greater agreement and usefulness of the content of the SeePain.Discussion: Overall, these results support the utility of the SeePain as a source of information regarding pain that may facilitate communication about pain and its management following SCI.

Approximately 60% of individuals with a spinal cord injury (SCI) experience neuropathic pain, which often persists despite the use of various pharmacological treatments. Increasingly, the potential analgesic effects of cannabis and cannabinoid products have been studied; however, little research has been conducted among those with SCI-related neuropathic pain. Therefore, the primary objective of the study was to investigate the perceived effects of cannabis and cannabinoid use on neuropathic pain among those who were currently or had previously used these approaches. Additionally, the study aimed to determine if common pain medications are being substituted by cannabis and cannabinoids. Participants (N = 342) were recruited from existing opt-in listserv sources within the United States. Of those, 227 met the inclusion criteria and were enrolled in the study. The participants took part in an anonymous online survey regarding past and current use of cannabis and their perceived effects on neuropathic pain, including the use of pain medication. Those in the sample reported average neuropathic pain intensity scores over the past week of 6.8 ± 2.1 (0 to 10 scale), reflecting a high moderate to severe level of pain. Additionally, 87.9% noted that cannabis reduced their neuropathic pain intensity by more than 30%, and 92.3% reported that cannabis helped them to better deal with their neuropathic pain symptoms. Most participants (83.3%) also reported substituting their pain medications with cannabis, with the most substituted medication categories being opioids (47.0%), gabapentinoids (42.8%) and over-the-counter pain medications (42.2%). These preliminary results suggest that cannabis and cannabinoids may be effective in reducing neuropathic pain among those with SCI and may help to limit the need for certain pain medications.