Highlights
- •Half of individuals experience stable moderate pain during initial spinal cord injury rehabilitation.
- •Pain decreases in persons with higher optimism, more social support, and less anxiety.
- •Psychosocial resources and mental health present promising pain intervention targets.
Abstract
Objective
To identify classes of pain trajectories during initial rehabilitation after spinal
cord injury (SCI) and to investigate whether psychosocial resources and mental health
predict pain trajectory membership.
Design
Longitudinal analysis with prospective data from the Inception Cohort of the Swiss
Spinal Cord Injury Cohort Study.
Setting
Initial rehabilitation in 4 SCI specialized rehabilitation centers in Switzerland.
Participants
Individuals aged ≥16 years with newly diagnosed traumatic or nontraumatic SCI admitted
to initial rehabilitation between August 2015 and April 2021 (N=343).
Intervention
Not applicable.
Main Outcome Measures
Pain intensity was assessed at 4 time points (4, 12, and 24 weeks after SCI and at
discharge) with 1 item of the International SCI Basic Pain Dataset asking participants
to rate their average pain intensity experienced during the past week on a 0-10 numeric
rating scale.
Results
Four pain trajectories were identified by latent process mixed modeling: stable moderate
pain (N=170, 49.6%), decreasing pain (N=36, 10.5%), increasing pain (N=16, 4.7%),
and stable low pain (N=121, 35.3%). Participants with higher optimism (β = 0.12; 95%
confidence interval [CI], 0.03-0.22), more social support (β = 0.30; 95% CI, 0.01-0.59),
and less anxiety (β = −0.13; 95% CI, −0.24 to −0.01) 1 month after injury were more
likely to be classified to the decreasing pain than the stable moderate pain trajectory
in adjusted analyses. Self-efficacy, purpose in life, and depressive symptoms did
not predict this allocation when adjusting for sociodemographics, SCI characteristics,
and pain medication.
Conclusions
These findings highlight the importance of psychosocial resources and mental health
for early pain trajectories after SCI onset and support the notion that strengthening
psychosocial resources and mental health early after SCI could present promising targets
in pain management.
List of abbreviations:
AIC (Akaike information criterion), CI (confidence interval), LPMM (latent process mixed model), SCI (spinal cord injury)Keywords
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Article info
Publication history
Published online: February 10, 2022
Accepted:
January 14,
2022
Received in revised form:
January 4,
2022
Received:
August 6,
2021
Footnotes
Supported by Swiss Paraplegic Research.
Disclosures: none.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
