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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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European Journal of Physical and Rehabilitation Medicine 2016 Ottobre;52(5):630-6
Pain severity and mobility one year after spinal cord injury: a multicenter, cross-sectional study
Bianca F. MARCONDES 1, Shruti SREEPATHI 3, Justin MARKOWSKI 3, Dung NGUYEN 3, Shannon R. STOCK 3, Sandra CARVALHO 1, 4, Denise TATE 5, Ross ZAFONTE 2, 6, Leslie R. MORSE 2, 6, Felipe FREGNI 1, 2 ✉
1 Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 2 Spaulding-Harvard Spinal Cord Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; 3 Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA; 4 Neuropsychophysiology Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal; 5 University of Michigan Spinal Cord Injury Model System, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA; 6 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
BACKGROUND: Following a spinal cord injury, patients are often burdened by chronic pain. Preliminary research points to activation of the motor cortex through increased mobility as a potential means of alleviating postinjury chronic pain.
AIM: The aim of this study was to assess the relationship between pain severity and mobility among patients who have sustained a traumatic spinal cord injury while controlling for clinically-relevant covariates.
DESIGN: A multi-center, cross-sectional study.
SETTING: The SCIMS is composed of 14 centers, all located in the United States and funded by the National Institute on Disability and Rehabilitation Research (NIDRR).
POPULATION: The study cohort included 1980 patients who completed the one-year SCIMS follow-up assessment between October 2000- December 2013.
METHODS: A multi-center, cross-sectional study was performed to assess the impact of mobility on self-reported pain using information from 1980 subjects who sustained a traumatic spinal cord injury and completed a year-one follow-up interview between October 2000 and December 2013. Patient information was acquired using the Spinal Cord Injury National Database, compiled by the affiliated Spinal Cord Injury Model Systems. Analyses included a multivariable linear regression of patients’ self-reported pain scores on mobility, quantified using the CHART-SF mobility total score, and other clinically relevant covariates.
RESULTS: After controlling for potential confounders, a significant quadratic relationship between mobility and patients’ self-reported pain was observed (P=0.016). Furthermore, female gender, “unemployed” occupational status, paraplegia, and the presence of depressive symptoms were associated with significantly higher pain scores (P<0.02 for all variables). Statistically significant quadratic associations between pain scores and age at injury, life satisfaction total score, and the CHART-SF occupational total subscale were also observed (P≤0.03 for all variables).
CONCLUSIONS: Among patients with moderate to high levels of mobility, pain scores decreased with increasing mobility.
CLINICAL REHABILITATION IMPACT: Enhancing a patient’s physical activity by increasing his or her mobility may reduce neuropathic pain if begun shortly after a spinal cord injury.