Dissertation Defence: Emotions, Thoughts, Behaviours, and Pain After Spinal Cord Injury

Robert C. Buren, supervised by Dr. Kathleen Martin Ginis, will defend their dissertation titled “Emotions, Thoughts, Behaviours, and Pain After Spinal Cord Injury: A Behaviour-First Approach to Neuropathic Pain” in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Kinesiology.

An abstract for Robert C. Buren’s dissertation is included below.

Examinations are open to all members of the campus community as well as the general public. Registration is not required for in-person exams.

Abstract

Chronic neuropathic pain affects most individuals living with spinal cord injury (SCI) and remains one of the most persistent and undertreated consequences of injury. First-line treatments are primarily pharmacological, often providing limited benefit with significant side effects. Despite growing recognition of the role psychosocial and behavioural factors play in pain experience, SCI pain research has remained largely biomedical in its orientation, leaving modifiable targets underexplored and underutilized. This dissertation examined the relationships between emotions, thoughts, behaviours, and pain among adults with SCI across three sequential studies.

Study 1 was a scoping review of cognitive behavioural therapies (CBT) for neuropathic pain. Six CBT modalities were evaluated across five pain etiologies in 20 original studies involving 1,009 participants. A reduction in neuropathic pain was observed in 85% of studies regardless of CBT type or etiology, identifying where the evidence was promising, inconsistent, and gaps remained. Striking heterogeneity in outcome measurement was identified, pointing to a critical need for standardization in the field.

Study 2 was a national cross-sectional survey of 200 English-speaking adults with SCI that examined psychosocial predictors of pain severity and interference. Psychosocial variables, particularly emotions, significantly predicted pain interference but not severity. Anger and depression emerged as meaningful predictors, explaining substantial variance in interference beyond sociodemographic and injury-related characteristics, and highlighting emotions as modifiable targets for intervention.

Study 3 evaluated a remotely delivered, behaviour-first self-management intervention facilitated by persons with lived experience of SCI pain. Using an N-of-1 design, individual trajectories and group-level effects were examined across a 10-week program. Twelve adults completed the 10-week program with 100% adherence. Meaningful improvements were observed in tool use, pain severity, interference, catastrophizing, fear of movement, and pain self-efficacy. Effects were strongest for behavioural engagement and psychosocial regulatory processes, supporting these as plausible pathways through which pain reductions occur.

Collectively, these study findings support a behaviour-first approach to SCI neuropathic pain research and care, positioning sustained self-management behaviours and emotions as central rather than secondary to the pain experience. Future work should prioritize controlled replication using randomized N-of-1 designs, longer follow-up, and formal mediation testing of the proposed behavioural and psychosocial pathways.