Principles for Chronic Pain Management in the Adult Traumatic Spinal Cord Injury Population at the Primary Healthcare Level, in a Developing Context: A Delphi Study.

Introduction: Individuals with traumatic spinal cord injury (TSCI) are dissatisfied with their chronic pain management. A biopsychosocial approach has been proven to improve chronic pain. Guidelines are required to holistically manage chronic pain in the TSCI population. Methods: A Delphi study was conducted to gain consensus on design principles for chronic pain in the TSCI population, for the Western Cape of South Africa. Purposive sampling was used to recruit first-line primary health care providers from primary health care settings in the Cape Metropolitan region. Participants were asked for consent on principles pertaining to the assessment, education and planning for chronic pain management, pharmacological and non-pharmacological therapy for neuropathic and nociceptive pain, as well as the monitoring of chronic pain and referral of resistant pain. For consensus analysis, a median of 3.24 or higher was considered in addition to two categories of consensus, namely weak consensus (50%-70%) and strong consensus (>70%). Results: The first-line primary health care providers agreed on eighteen principles to guide chronic pain management in the TSCI population. Consensus could not be reached on the second to fourth line pharmacological management of neuropathic pain. Conclusion: The agreed upon design principles may be considered as starting points for implementation at the primary health care level in the Western Cape of South Africa.