ORIGINAL RESEARCH| Volume 103, ISSUE 7, P1294-1302, July 2022

Pain Trajectories During Initial Rehabilitation After Spinal Cord Injury: Do Psychosocial Resources and Mental Health Predict Trajectories?

Published:February 10, 2022DOI:


      • 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.



      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.


      Longitudinal analysis with prospective data from the Inception Cohort of the Swiss Spinal Cord Injury Cohort Study.


      Initial rehabilitation in 4 SCI specialized rehabilitation centers in Switzerland.


      Individuals aged ≥16 years with newly diagnosed traumatic or nontraumatic SCI admitted to initial rehabilitation between August 2015 and April 2021 (N=343).


      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.


      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.


      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)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hunt C
        • Moman R
        • Peterson A
        • et al.
        Prevalence of chronic pain after spinal cord injury: a systematic review and meta-analysis.
        Reg Anesth Pain Med. 2021; 46: 328-336
        • Müller R
        • Brinkhof MW
        • Arnet U
        • et al.
        Prevalence and associated factors of pain in the Swiss spinal cord injury population.
        Spinal Cord. 2017; 55: 346-354
        • Widerström-Noga EG
        • Felipe-Cuervo E
        • Yezierski RP
        Chronic pain after spinal injury: interference with sleep and daily activities.
        Arch Phys Med Rehabil. 2001; 82: 1571-1577
        • Jensen M
        • Hoffman A
        • Cardenas D
        Chronic pain in individuals with spinal cord injury: a survey and longitudinal study.
        Spinal Cord. 2005; 43: 704-712
        • Williams R
        • Murray A
        Prevalence of depression after spinal cord injury: a meta-analysis.
        Arch Phys Med Rehabil. 2015; 96: 133-140
        • Schwegler U
        • Fekete C
        • Finger M
        • Karcz K
        • Staubli S
        • Brinkhof MW
        Labor market participation of individuals with spinal cord injury living in Switzerland: determinants of between-person differences and counterfactual evaluation of their instrumental value for policy.
        Spinal Cord. 2021; 59: 429-440
        • Carrard V
        • Kunz S
        • Peter C
        Mental health, quality of life, self-efficacy, and social support of individuals living with spinal cord injury in Switzerland compared to that of the general population.
        Spinal Cord. 2021; 59: 398-409
        • Cohen SP
        • Vase L
        • Hooten WM
        Chronic pain: an update on burden, best practices, and new advances.
        Lancet. 2021; 397: 2082-2097
        • Nielsen S
        • Faaborg P
        • Christensen P
        • Krogh K
        • Finnerup N
        Chronic abdominal pain in long-term spinal cord injury: a follow-up study.
        Spinal Cord. 2017; 55: 290-293
        • Cruz-Almeida Y
        • Martinez-Arizala A
        • Widerström-Noga EG
        Chronicity of pain associated with spinal cord injury: a longitudinal analysis.
        J Rehabil Res Dev. 2005; 42: 585-594
        • Walford SL
        • Requejo PS
        • Mulroy SJ
        • Neptune RR
        Predictors of shoulder pain in manual wheelchair users.
        Clin Biomech. 2019; 65: 1-12
        • Eriks-Hoogland IE
        • Hoekstra T
        • de Groot S
        • Stucki G
        • Post MW
        • van der Woude LH
        Trajectories of musculoskeletal shoulder pain after spinal cord injury: identification and predictors.
        J Spinal Cord Med. 2014; 37: 288-298
        • Finnerup NB
        • Norrbrink C
        • Trok K
        • et al.
        Phenotypes and predictors of pain following traumatic spinal cord injury: a prospective study.
        J Pain. 2014; 15: 40-48
        • Siddall PJ
        • McClelland JM
        • Rutkowski SB
        • Cousins MJ
        A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury.
        Pain. 2003; 103: 249-257
        • Warner FM
        • Cragg JJ
        • Jutzeler CR
        • et al.
        Progression of neuropathic pain after acute spinal cord injury: a meta-analysis and framework for clinical trials.
        J Neurotrauma. 2018; 36: 1461-1468
        • Finnerup N
        • Jensen M
        • Norrbrink C
        • et al.
        A prospective study of pain and psychological functioning following traumatic spinal cord injury.
        Spinal Cord. 2016; 54: 816-821
        • Zeilig G
        • Enosh S
        • Rubin-Asher D
        • Lehr B
        • Defrin R.
        The nature and course of sensory changes following spinal cord injury: predictive properties and implications on the mechanism of central pain.
        Brain. 2012; 135: 418-430
        • Finan PH
        • Garland EL
        The role of positive affect in pain and its treatment.
        Clin J Pain. 2015; 31: 177-187
        • Lumley MA
        • Cohen JL
        • Borszcz GS
        • et al.
        Pain and emotion: a biopsychosocial review of recent research.
        J Clin Psychol. 2011; 67: 942-968
        • Hanssen MM
        • Peters ML
        • Vlaeyen JW
        • Meevissen YM
        • Vancleef LM
        Optimism lowers pain: evidence of the causal status and underlying mechanisms.
        Pain. 2013; 154: 53-58
        • Basten-Günther J
        • Peters M
        • Lautenbacher S
        Optimism and the experience of pain: a systematic review.
        Behav Med. 2019; 45: 323-339
        • Smith BW
        • Tooley EM
        • Montague EQ
        • Robinson AE
        • Cosper CJ
        • Mullins PG
        The role of resilience and purpose in life in habituation to heat and cold pain.
        J Pain. 2009; 10: 493-500
        • Younger J
        • Aron A
        • Parke S
        • Chatterjee N
        • Mackey S
        Viewing pictures of a romantic partner reduces experimental pain: involvement of neural reward systems.
        PLoS One. 2010; 5: e13309
        • Roberts MH
        • Klatzkin RR
        • Mechlin B
        Social support attenuates physiological stress responses and experimental pain sensitivity to cold pressor pain.
        Ann Behav Med. 2015; 49: 557-569
        • Rosenberger PH
        • Kerns R
        • Jokl P
        • Ickovics JR
        Mood and attitude predict pain outcomes following arthroscopic knee surgery.
        Ann Behav Med. 2009; 37: 70-76
        • Ronaldson A
        • Poole L
        • Kidd T
        • Leigh E
        • Jahangiri M
        • Steptoe A
        Optimism measured pre-operatively is associated with reduced pain intensity and physical symptom reporting after coronary artery bypass graft surgery.
        J Psychosom Res. 2014; 77: 278-282
        • Gramke H-F
        • de Rijke JM
        • van Kleef M
        • et al.
        Predictive factors of postoperative pain after day-case surgery.
        Clin J Pain. 2009; 25: 455-460
        • Hoofwijk D
        • Fiddelers AA
        • Peters ML
        • et al.
        Prevalence and predictive factors of chronic postsurgical pain and poor global recovery 1 year after outpatient surgery.
        Clin J Pain. 2015; 31: 1017-1025
        • Panattoni N
        • Longo UG
        • De Salvatore S
        • et al.
        The influence of psychosocial factors on patient-reported outcome measures in rotator cuff tears pre-and post-surgery: a systematic review.
        Qual Life Res. 2022; 31: 91-116
        • Lautenbacher S
        • Huber C
        • Schöfer D
        • et al.
        Attentional and emotional mechanisms related to pain as predictors of chronic postoperative pain: a comparison with other psychological and physiological predictors.
        Pain. 2010; 151: 722-731
        • van Diemen T
        • Crul T
        • van Nes I
        • Group S-S
        • Geertzen JH
        • Post MW
        Associations between self-efficacy and secondary health conditions in people living with spinal cord injury: a systematic review and meta-analysis.
        Arch Phys Med Rehabil. 2017; 98: 2566-2577
        • Peter C
        • Müller R
        • Post MW
        • van Leeuwen C
        • Werner CS
        • Geyh S
        Depression in spinal cord injury: Assessing the role of psychological resources.
        Rehabil Psychol. 2015; 60: 67-80
        • Jensen MP
        • Moore MR
        • Bockow TB
        • Ehde DM
        • Engel JM
        Psychosocial factors and adjustment to chronic pain in persons with physical disabilities: a systematic review.
        Arch Phys Med Rehabil. 2011; 92: 146-160
        • Braunwalder C
        • Müller R
        • Kunz S
        • Tough H
        • Landmann G
        • Fekete C
        Psychosocial resources and chronic pain in individuals with spinal cord injury: evidence from the second Swiss national community survey.
        Spinal Cord. 2021; 59: 410-418
        • Battalio SL
        • Glette M
        • Alschuler KN
        • Jensen MP
        Anxiety, depression, and function in individuals with chronic physical conditions: a longitudinal analysis.
        Rehabil Psychol. 2018; 63: 532-541
        • Craig A
        • Guest R
        • Tran Y
        • Perry KN
        • Middleton J
        Pain catastrophizing and negative mood states after spinal cord injury: transitioning from inpatient rehabilitation into the community.
        J Pain. 2017; 18: 800-810
        • Raichle KA
        • Hanley M
        • Jensen MP
        • Cardenas DD
        Cognitions, coping, and social environment predict adjustment to pain in spinal cord injury.
        J Pain. 2007; 8: 718-729
        • Hodel J
        • Ehrmann C
        • Stucki G
        • Bickenbach JE
        • Prodinger B
        • SwiSCI Study Group
        Examining the complexity of functioning in persons with spinal cord injury attending first rehabilitation in Switzerland using structural equation modelling.
        Spinal Cord. 2020; 58: 570-580
        • Adams M
        • Weatherall M
        • Bell E
        A cohort study of the association between psychosocial factors and pain in patients with spinal cord injury and stroke.
        NeuroRehabilitation. 2019; 45: 419-427
        • Aparicio MG
        • Carrard V
        • Morselli D
        • et al.
        Profiles of psychological adaptation outcomes at discharge from spinal cord injury inpatient rehabilitation.
        Arch Phys Med Rehabil. 2020; 101: 401-411
        • Fekete C
        • Gurtner B
        • Kunz S
        • et al.
        Inception cohort of the Swiss Spinal Cord Injury Cohort Study (SwiSCI): design, participant characteristics, response rates and non-response.
        J Rehabil Med. 2021; 53: jrm00159
        • Widerström-Noga E
        • Biering-Sørensen F
        • Bryce T
        • et al.
        The international spinal cord injury pain basic data set (version 2.0).
        Spinal Cord. 2014; 52: 282-286
        • Ferreira-Valente MA
        • Pais-Ribeiro JL
        • Jensen MP
        Validity of four pain intensity rating scales.
        Pain. 2011; 152: 2399-2404
        • Schwarzer R
        • Jerusalem M
        Generalized self-efficacy scale.
        in: Weinman J Wright S Johnston M Measures in health psychology: a user's portfolio. Causal and control beliefs. NFER-Nelson Publishing Company, Windsor, UK1995: 35-36
        • Peter C
        • Cieza A
        • Geyh S
        Rasch analysis of the General Self-Efficacy Scale in spinal cord injury.
        J Health Psychol. 2014; 19: 544-555
        • Schulenberg SE
        • Schnetzer LW
        • Buchanan EM
        The Purpose in Life Test–Short Form: development and psychometric support.
        J Happiness Stud. 2011; 12: 861-876
        • Peter C
        • Schulenberg SE
        • Buchanan EM
        • Prodinger B
        • Geyh S
        Rasch analysis of measurement instruments capturing psychological personal factors in persons with spinal cord injury.
        J Rehabil Med. 2016; 48: 175-188
        • Scheier MF
        • Carver CS
        • Bridges MW
        Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test.
        J Pers Soc Psychol. 1994; 67: 1063-1078
        • Glaesmer H
        • Rief W
        • Martin A
        • et al.
        Psychometric properties and population-based norms of the Life Orientation Test Revised (LOT-R).
        Br J Health Psychol. 2012; 17: 432-445
        • Tillmann R
        • Voorpostel M
        • Kuhn U
        • et al.
        The Swiss household panel study: observing social change since 1999.
        Longitud Life Course Stud. 2016; 7: 64-78
        • Zigmond AS
        • Snaith RP
        The Hospital Anxiety and Depression Scale.
        Acta Psychiatr Scand. 1983; 67: 361-370
        • Müller R
        • Cieza A
        • Geyh S
        Rasch analysis of the Hospital Anxiety and Depression Scale in spinal cord injury.
        Rehabil Psychol. 2012; 57: 214-223
        • Proust-Lima C
        • Philipps V
        • Liquet B
        Estimation of extended mixed models using latent classes and latent processes: the R package lcmm.
        J Stat Softw. 2017; 78: 1-56
      1. Proust-Lima C, Philipps V, Diakite A, Liquet B. lcmm: extended mixed models using latent classes and latent processes. R package version: 1.8.1. Available at: Accessed June 16, 2021.

        • Bushnell MC
        • Čeko M
        • Low LA
        Cognitive and emotional control of pain and its disruption in chronic pain.
        Nat Rev Neurosci. 2013; 14: 502-511
        • Braunwalder C
        • Müller R
        • Glisic M
        • Fekete C
        Are positive psychology interventions efficacious in chronic pain treatment? A systematic review and meta-analysis of randomized controlled trials.
        Pain Med. 2022; 23: 122-136
        • Zale EL
        • Ditre JW
        Pain-related fear, disability, and the fear-avoidance model of chronic pain.
        Curr Opin Psychol. 2015; 5: 24-30
        • Bombardier CH
        • Adams LM
        • Fann JR
        • Hoffman JM
        Depression trajectories during the first year after spinal cord injury.
        Arch Phys Med Rehabil. 2016; 97: 196-203
        • Müller R
        • Segerer W
        • Ronca E
        • et al.
        Inducing positive emotions to reduce chronic pain: a randomized controlled trial of positive psychology exercises.
        Disabil Rehabil. 2020 Dec 2; ([Epub ahead of print])
        • Nadinda PG
        • van Ryckeghem DML
        • Peters ML
        Can perioperative psychological interventions decrease the risk of post-surgical pain and disability? A systematic review and meta-analysis of randomized controlled trials.
        Pain. 2021 Oct 26; ([Epub ahead of print])