Browsing by Author "Williams, Tammy-Lee"

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    Exploration of the experiences of persons in the traumatic spinal cord injury population in relation to chronic pain management
    (MDPI, 2023) Williams, Tammy-Lee; Joseph, Conran; Nilsson-Wikmar, Lena
    Chronic pain amongst individuals with traumatic and nontraumatic spinal cord injury (SCI) has high prevalence rates, with severe impact on the activities of daily living, mood, sleep and quality of life. This study aimed to explore the experiences and challenges of chronic pain management amongst the traumatic spinal cord injury (TSCI) population in the Western Cape region of South Africa. A qualitative descriptive approach was chosen for the study, in which 13 individuals living with TSCI were purposively recruited and interviewed telephonically. An inductive thematic analytic approach was used. The results indicate ineffectiveness of standard pain management, with a lack of education regarding pain physiology and pain management strategies as well as unbalanced decision-making between clinician and patient. Thus, patients develop coping strategies to survive with pain. Current pain regimes are suboptimal at best, underpinned by the lack of clarity or a mutually agreed plan to mitigate and eradicate pain.
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    Guidelines for chronic pain in adult spinal cord injury population: scoping review
    (AOSIS (Pty) Ltd, 2024) Williams, Tammy-Lee; Phillips, Joliana; Joseph, Conran
    Background: Chronic pain among survivors of spinal cord injury (SCI) hurts physical and mental health. Persons with SCI have demonstrated dissatisfaction with the management of their chronic pain. Objectives: This study aimed to identify existing clinical practice guidelines for chronic pain in the SCI population. Method: A scoping review was conducted across various databases available at the University of the Western Cape, in addition to guideline clearing houses (BioMedCentral, Cambridge journals online, CINAHL, Cochrane library, Medline [EbscoHost], Medline [Pubmed], Sabinet Reference, SAGE Journals Online, ScienceDirect, SCOPUS, Wiley Online Library, Springerlink, PubMed, Guideline Central, and agency for healthcare research and quality). The population consisted of adults with SCI, and the interventions that were included were pharmacological and nonpharmacological management of chronic pain. Guidelines that met the inclusion criteria were critically appraised by two reviewers from this study using the AGREE II instrument. Inter-rater reliability was calculated using SPSS 27, and Cohen’s kappa coefficients were established.
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    Healthcare providers perspective of chronic pain management in personswith traumatic spinal cord injury accessing the public system in a region of South Africa
    (Taylor and Francis Ltd., 2024) Williams, Tammy-Lee; Nilsson Wikmar, Lena; Phillips, Joliana
    Purpose: Persons with traumatic spinal cord injury (PWTSCI) have expressed a lack of education from healthcare providers and poor shared-decision making between providers and clients. The aim was to explore the healthcare providers’ perspective on factors influencing the optimal management of chronic pain. Methods: Healthcare providers were recruited from two institutions at tertiary healthcare level. Interviews explored current chronic pain management practices, influencing factors and recommendations for improvement. Data saturation occurred after interviewing 11 participants. Thematic analysis was used through a socio-ecological model. Results: The challenges to optimal pain management include appropriate assessment and management of psychological health (intrapersonal level), substance abuse amongst patients (intrapersonal level), access to medication for providers and lack of knowledge by providers (interpersonal and organizational level). To improve chronic pain management, an interdisciplinary team approach should be operationalized at policy and organizational level, monitoring and adjustment of interventions should take place (interpersonal), and family members/caregivers should be involved in the planning and monitoring (interpersonal). Conclusion: Factors, at the interpersonal, intrapersonal, organizational and policy levels, influence optimal chronic pain management in the traumatic spinal cord injury (TSCI) population. To mitigate challenges, guidelines for chronic pain management should be developed, particularly for low-resourced developing countries.
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    Management principles for chronic pain in survivors of traumatic spinal cord injury
    (University of the Western Cape, 2024) Williams, Tammy-Lee; Phillips, Joliana
    Chronic pain is a common secondary complication in the traumatic spinal cord injury (TSCI) population and has been documented across the world impacting on quality of life (QOL) as well as activities of daily living (ADL’s). Furthermore, chronic pain also impacts on psychological factors resulting in poorer mental health. The current management of chronic pain, globally, is largely based on a predominant pharmacological approach, leading to suboptimal outcomes. Both researchers and persons with TSCI (PWTSCI) are contesting the medically-oriented approach to pain management owing to the complexity of chronic pain and the undesirable side-effects associated with pharmacological use. Within the disorder of chronic pain, a complex interaction of biological, social and psychological factors plays a role in the representation of chronic pain, and, therefore, pharmacological approaches alone cannot be sufficient to treat this multifaceted disorder. In the TSCI population, individuals have highlighted their needs for non-pharmacological interventions to manage their chronic pain. As early as 1977, George Engel proposed to transform the medical model by adapting a biopsychosocial approach to pain management. In South Africa no guideline exists to guide healthcare providers along this biopsychosocial approach in the TSCI population. This doctoral research project, therefore, aimed to develop design principles for the management of chronic pain in the TSCI population.
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    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
    (SAGE, 2025) Williams, Tammy-Lee; Wikmar, Lena Nilsson; Joseph, Conran
    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.