Theodore M. Cole

Behavior modification of chronic pain: a treatment program by a multidisciplinary team.

A treatment program for chronic pain is reported which focuses on modification of patient pain behavior. After an outpatient pain clinic screening by a multidisciplinary team, the patient with chronic pain (duration of 6 months or longer) is admitted for a 7--8 week inpatient program followed by a 4-week outpatient period. The first week of the inpatient program is used for evaluation of pain behaviors, recording use of pain medications, activity levels, and tolerance for special conditioning exercises. The program is aimed at extinguishing pain behaviors and use of pain medications, increasing activity level, reinforcing well behaviors, and returning patients to full active lives, normal for their sex and age. Of the 34 patients completing the program and returning to full active normal lives, 74% (25) have maintained this attained goal at the time of follow-up from 6 months to 7 years later.

A new programme of sex education and counselling for spinal cord injured adults and health care professionals

A new programme in sex education and counselling for spinal cord injured adults and health care professionals has been described. The format of the 2-day desensitising-resensitising programme included exposure to a programmed assortment of explicit slides and films of sexual activity. Periodic small group discussions led by trained group leaders constituted the most important part. The results suggest that continued sexual interest, activity and satisfaction can be anticipated for many paraplegics and quadriplegics. An accepting, experimental attitude toward sexual activity promotes satisfaction with an interested and caring partner. However, many health professionals deliver inadequate sexual counselling to patients with spinal cord injury. This may add to the sum of the disabilities carried by the paraplegic and quadriplegic adult.

Sexual Counseling of the Physically Disabled

Sexual satisfaction and feelings of self-esteem play an important role in the ability to adapt to an acquired physical disability. A framework has been presented to show how sexual function is affected by different types of physical disability, and spinal cord injury has been selected as a specific example. Sexual counseling for the disabled differs little from that for the able-bodied--the same principles apply. It is appropriate to remind not only the counselor but also the disabled that (1) loss of sensation does not mean loss of feelings, (2) loss of potency does not mean loss of ability, (3) loss of urinary continence does not mean loss of penile competence, and (4) loss of genitalia does not mean loss of sexuality.

Rehabilitation professionals and sexual counseling for spinal cord injured adults

The Michigan Rehabilitation Association (M.R.A.) and the Program in Human Sexuality of the University of Minnesota collaborated to produce a 1-day seminar on sexual function in spinal cord injury. Evaluation of the participants and the seminar showed that the program was beneficial for most and harmful for few. Questionnaire responses indicated that few M.R.A. members are currently doing sexual counseling but many see an opportunity to do so. A relationship appeared between those who have received some form of training in sexual counseling and those who are doing counseling with clients. It is postulated that frank and sincere discussion of sexuality may improve rapport between client and counselor. However, before such an interaction can comfortably take place, the counselor may gain from an opportunity to examine his or her own attitudes toward human sexuality and gather more information about the sexuality of physically disabled adults.

Sexuality and Physical Disabilities

Physical disabilities which produce physical handicaps are increasing in frequency. As many as 10% of the general adult population have a physical handicap (Finley, 1972). Types of handicaps include disabilities which have their onset at birth or in early life, those which have an abrupt onset after puberty, disabilities which have progressive courses and begin before puberty, and progressive disabilities which begin after puberty. Examples include arthritis, amputations, deformities, cerebral vascular disease, coronary heart disease, kidney failure and transplant, blindness, deafness, developmental disabilities, paralysis, and disfigurements. In spite of common belief to the contrary, many disabled people report that their disabilities do not alter their sexuality or libido (Richardson, 1972).

Spinal Cord Injury and Trauma

Trauma of the spinal cord has almost always been associated with feelings of hopelessness and foreboding. The first recorded reference to injury of the spinal cord was found in the Edwin Smith Surgical Papyrus, written about 2500–3000 B. C. “Thou shouldst say concerning him, one having a dislocation of the vertebrae of his neck while he is unconscious of his two legs and two arms and his urine dribbles. An ailment not to be treated.”1 Almost 5,000 years later, Robert Penn Warren described a quadriplegic in his novel All The Kings Men (1946). He describes a lifetime of paralysis, hopelessness, and impending death.

The evaluation of sexual health services in a medical setting.

An interdisciplinary Sexual Health Services unit has been established at the University of Minnesota Medical School that offers counseling and treatment programs for a wide variety of sex-related concerns and problems. The programs are based on the principles of responsibility for self, permission to be sexual, the use of reeducation, the facilitation of increased awareness in clients, and structured behavior change. The programs have been evaluated according to client satisfaction with the extent to which they have met pretreatment goals and according to results of pre/posttesting with objective instruments. One year follow-up results from 131 clients and immediate posttreatment results from 411 clients show positive change in a large majority of cases.