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Researchers at Lawson Health Research Institute are the first in Canada to develop clinical practice guidelines for managing neuropathic pain with patients who have experienced a spinal cord injury (SCI).

Neuropathic pain is complex and chronic, and is the most common complication reported by people following SCI. The research team worked with care providers at Parkwood Institute, part of the St. Joseph’s Health Care London family, and an international panel to address the complex and unique challenges for managing pain during recovery and rehabilitation.

In 2003, Dan Harvey sustained a spinal injury after falling off a trampoline. Using his personal experience, as well as his experiences meeting with newly injured people, Harvey contributed to the development of the new guidelines.

“Neuropathic pain – and pain in general – affects every person with a spinal cord injury very differently. Some people have it, some people don’t. But for those who do have it, it can make rehabilitation and recovery much more difficult,” explains Harvey.

“On top of just learning how to use your body again, you also have to deal with various forms of physical pains, which can make it challenging to mentally adapt to an injury.”

For those with chronic pain, it may be hard to just get out of bed in the morning, feel well enough to leave the house, or even fall asleep. “I have fairly extensive neuropathic pain, so I’m well aware of how difficult it can be to get a full night’s sleep, or show attentiveness at work or at school when it literally feels like your legs are on fire,” says Harvey.

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Dr. Eldon Loh, Lawson Researcher and Physical Medicine and Rehabilitation Specialist at St. Joseph’s, and his team recognized that pain can be an overlooked part of a spinal cord injury and plays a major factor in the success of rehabilitation. It’s difficult for someone in pain to participate fully in their own recovery, and so long-term disability becomes more likely. Pain is difficult to manage and it often takes multiple approaches to find something that works for each person.

“This is a starting point for us to standardize how we approach pain in the clinic. We have identified gaps and offered recommendations to not only manage the pain, but also ensure that our patients can fully benefit from rehabilitation,” says Dr. Loh.

The results of the three-year process led to recommendations for screening and diagnosis, treatment and models of care. Important clinical considerations accompany each recommendation.

“For those in hospital following an injury, it’s about making sure they can be as independent as possible before discharge. Over time, we want to keep pain levels under control so that they are able to live life to the fullest,” adds Dr. Loh.

The research will inform new tools and resources for care providers and patients.

Harvey believes the guidelines will have a tremendous impact for patients whose pain may have been overlooked. “Pain can be created through many different avenues and the effects can snowball after a person is discharged and sent home. If you don’t check all of the boxes, you might be missing a very important item.”

The new guidelines have been published in the international journal Spinal Cord. The Ontario Neurotrauma Foundation and Rick Hansen Institute provided funding for the research study. 

A special thanks to individuals from St. Joseph's who were involved in the project: Steve Orenczuk, Patrick Potter, Keith Sequiera, Lindsey Guilbault, Robert Teasell, Anna Kras-Dupuis, Dalton Wolfe, Alba Casalino and Dwight Moulin.  

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Chaired by Dr. Manuel Montero-Odasso, Scientist at Lawson Health Research Institute, a group of 96 experts from 39 countries and 36 societies and agencies in Geriatric Medicine and Aging have come together to develop the “World Guidelines for Falls Prevention and Management for Older Adults: A Global Initiative.”

Published in Age and Ageing, the official journal of the British Geriatric Society, the guidelines provide recommendations to clinicians working with older adults to identify and assess fall risks.

“The global population is aging. Thanks to social and medical advances, some chronic conditions are diminishing proportionally. This is not the case for falls,” says Dr. Montero-Odasso, who is also a Geriatrician at St. Joseph’s Health Care London’s Parkwood Institute and a Professor at Western University’s Schulich School of Medicine & Dentistry. “Unfortunately, falls and related injuries among older adults are increasing and there is no sign of future decline.”

With new evidence and studies released since previous guidelines were published more than a decade ago, experts felt it was the right time for an update and an opportunity to incorporate a worldwide perspective

“Besides the rigorous methodology that 11 international working groups followed to provide new meta-analyses, including several new Cochrane collaborations, this World Falls Guidelines are, to the best of our knowledge, the first clinical practice guidelines in fall prevention to include a panel of older adults with lived experience in falls and mobility problems,” says Dr. Montero-Odasso. “They provided feedback, comments and opinions on our recommendations, making them considerably better and with wider applicability.”

Some key themes in the recommendations include: 

• Falls can be prevented, but it requires multidisciplinary management.
• Preventing falls has wider benefits for quality of life.
• Fall risk can be assessed by trained clinicians with simple resources. 
• A combination of interventions, including specific exercises to improve balance and strength, when delivered correctly, can effectively reduce fall risk in older adults.

Dr. Montero-Odasso says there was enough evidence to suggest that a global approach is needed to prevent falls in older adults and that “low risk does not mean no risk.” Even active older adults who are low risk should work on preventing loss of mobility and falls.

The next steps are for the guidelines to continue obtaining formalized endorsement of all the groups involved in the initiative and then for the guidelines to be fully implemented.

You can read the full guidelines here.