# Presentation: 140359

## Pain, Paralysis, or Sexual Dysfunction: Patient Perspectives

- David Binder M.D., Hammam Akbik M.D., Heidi K.Wennemer D.O., M.A., and Beth Tammaro BSN, RN, CRRN

**Abstract**
- One of the most common complications in SCI patients is chronic pain.  Anonymous questionnaires were distributed to all SCI patients attending a specialized pain clinic over a 9 month period of time. SCI patients were asked:  “If you could cure one problem, what would it be?”  Patients were given the choice of paralysis, sexual dysfunction, or pain.  Overall, of the 60 patients included in the study, 62% preferred pain relief, 33% chose alleviation of their paralysis , and 5%  indicated they favored the regaining of their sexual function. Addressing pain relief should be a top priority for physicians involved in the care of a patient with a spinal cord injury.
**Introduction**
- Persons with spinal cord injury can develop numerous complications that can further impair function and quality of life.  One of the most common complications in SCI patients is chronic pain.  Numerous studies have confirmed the pervasiveness of chronic pain in SCI, at times exceeding 90% of patients.
- Few studies have examined the choice a patient would make if they were able to eliminate one medical complication.  One previous study asked patients to consider the possibility of recovery of their SCI versus the resolution of pain and found that over one-third chose pain relief as their first choice.
- How pain is perceived by SCI patients has not been adequately studied.  To gain a better understanding of these perspectives, SCI patients were presented with a theoretical situation in which they were able to cure their paralysis, sexual dysfunction, or pain.
- The impact of pain in SCI is evident, but in the context of multiple medical issues, pain management can be insufficient.
- This study is intended to shed light on the unique perspectives of SCI patients enrolled in a multidisciplinary pain clinic created specifically for treatment of pain in SCI.

**Methods**
- Anonymous questionnaires were distributed to SCI patients attending a specialized pain clinic over a 9 month period of time.  This clinic was specifically established to address the unique pain issues encountered by patients with SCI.  Led by Dr. Hammam Akbik, the pain clinic has used a comprehensive multidisciplinary approach to effectively manage pain.
- On visiting the pain clinic, all SCI patients were asked:
-   “If you could cure one problem, what would it be?”
- Patients were given the choice of _paralysis, sexual dysfunction, or pain_.  60 questionnaires were analyzed and included in the study.
**Results**
-  Overall:
- 62% preferred Pain relief.
- 33% chose alleviation of their paralysis.
- 5% who indicated regaining sexual function.
- 41-50 year olds (N=18): overwhelmingly chose pain relief (94.4%) over paralysis (5.6%) and Sexual dysfunction (0.0%).
- .
- 51-60 year olds (N=21): The majority of patients (52.4%) chose paralysis over pain (33.3%) and sexual dysfunction (14.3%).
- 61-70 year olds (N=10): 70% favored pain relief ,30% elected paralysis. Sexual dysfunction=0.0%.
-  >71 years (N=7):  85.7% selected pain relief compared with 14.3% of patients that chose paralysis.  Sexual dysfunction= 0.0%.
- 31-40 year age group (N=3): all patients selected paralysis (100%).
-  20-30 years (N=1): paralysis.
**Conclusions**
- Overall, the majority of SCI patients would prefer to eliminate pain compared with other complications.
- Addressing pain relief should be a top priority for physicians involved in the care of a patient with a SCI.