Psychological and environmental aspects

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The person with SCI undergoes a huge adjustment in relationships, lifestyle, vocation, and self-image that need to be addressed and people with a severe SCI often have significant psychological distress, particularly in the acute post injury period.103[V] The presence of chronic pain may be an additional factor that prevents expected rehabilitation and return to employment and function in domestic life.5'6'22'104[V] Anxiety and depression are both normal responses to injury and often improve with time and the implementation of the person's inherent coping skills. In these people, formal intervention may not be required. However, for the minority who experience severe or chronic mood dysfunction that is having an impact on their ability to function and contributing to pain, intervention should be offered.

There are a variety of approaches for dealing with psychological and environmental contributors. These may include the use of anxiolytic and antidepressant medications and/or cognitive-behavioral treatment.105[III], 106 [III] It may also be necessary to address other external factors that are believed to be contributing to the pain. It is evident that psychological factors influence the experience of pain, and therefore it is likely that cognitive-behavioral interventions may improve the quality of life in pain patients. Relaxation techniques are suggested to be of benefit in SCI pain and may alter the attitude towards pain. Well-designed studies are needed to determine the effects of the non-pharmacological treatment of SCI pain.

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