Pain and Its Impact on Inpatient Rehabilitation for Acute Traumatic Spinal Cord Injury: Analysis of Observational Data Collected in the SCIRehab Study

Zanca, Jeanne M.; Dijkers, Marcel P.; Horn, Susan D.

doi:10.1016/j.apmr.2012.10.035

Cited by 28 publications

(32 citation statements)

References 32 publications

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“…T he high incidence and prevalence of pain following spinal cord injury (SCI) is well established [1][2][3][4][5][6] and associated with numerous poor health outcomes and low quality of life (QOL). 1,7,8 Although much of the literature on pain in SCI focuses on pain intensity, there is emerging interest in the role of pain interference or the extent to which pain interferes with daily activities of life.…”

mentioning

confidence: 99%

Depression, Pain Intensity, and Interference in Acute Spinal Cord Injury

Cuff

Fann

Bombardier

et al. 2014

Topics in Spinal Cord Injury Rehabilitation

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Background:The high prevalence of pain and depression in persons with spinal cord injury (SCI) is well known. However the link between pain intensity, interference, and depression, particularly in the acute period of injury, has not received sufficient attention in the literature. Objective: To investigate the relationship of depression, pain intensity, and pain interference in individuals undergoing acute inpatient rehabilitation for traumatic SCI. Methods: Participants completed a survey that included measures of depression (PHQ-9), pain intensity ("right now"), and pain interference (Brief Pain Inventory: general activity, mood, mobility, relations with others, sleep, and enjoyment of life). Demographic and injury characteristics and information about current use of antidepressants and pre-injury binge drinking also were collected. Hierarchical multiple regression was used to test depression models in 3 steps: (1) age, gender, days since injury, injury level, antidepressant use, and pre-injury binge drinking (controlling variables); (2) pain intensity; and (3) pain interference (each tested separately). Results: With one exception, pain interference was the only statistically significant independent variable in each of the final models. Although pain intensity accounted for only 0.2% to 1.2% of the depression variance, pain interference accounted for 13% to 26% of the variance in depression. Conclusion: Our results suggest that pain intensity alone is insufficient for understanding the relationship of pain and depression in acute SCI. Instead, the ways in which pain interferes with daily life appear to have a much greater bearing on depression than pain intensity alone in the acute setting.

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confidence: 99%

Depression, Pain Intensity, and Interference in Acute Spinal Cord Injury

Cuff

Fann

Bombardier

et al. 2014

Topics in Spinal Cord Injury Rehabilitation

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“…On the basis of the existing literature related to the prevalence of nonspecific musculoskeletal pain in ARU patients 1 ‐ 4 and the growing recognition of suboptimal vitamin D status in these patients, 6 ‐ 9 we performed an a priori sample size calculation. We assumed that in patients with 25(OH)D levels <20 ng/mL, the prevalence of nonspecific musculoskeletal pain was 35% vs 15% in patients with 25(OH)D levels ≥20 ng/mL.…”

Section: Methodsmentioning

confidence: 99%

“…Its prevalence varies greatly by the indication for admission, with values of 10%–70% having been reported 1 . ‐ 4 Nonspecific musculoskeletal pain is often difficult to manage since an identifiable pathology or anatomical basis for the pain cannot be found 5 . Inadequately controlled pain not only is a problem in itself but also may exacerbate musculoskeletal weakness, depression, anxiety, and poor sleep quality—all major factors that influence the general well‐being of ARU patients 6 .…”

Section: Introductionmentioning

confidence: 99%

Association Between Serum 25(OH)D Level and Nonspecific Musculoskeletal Pain in Acute Rehabilitation Unit Patients

Matossian-Motley

Drake

Samimi

et al. 2014

J Parenter Enteral Nutr

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Objective Nonspecific musculoskeletal pain can be difficult to manage in acute rehabilitation unit (ARU) patients. We investigated whether vitamin D status is a potential modifiable risk factor for nonspecific musculoskeletal pain in ARU patients. Materials and Methods This cross-sectional study focused on 414 adults from an inpatient ARU in Mission Viejo, California, between July 2011 and June 2012. On ARU admission, all patients had serum 25-hydroxyvitamin D (25(OH)D) levels measured and were assessed for nonspecific musculoskeletal pain. We performed multivariable logistic regression to test the association of serum 25(OH)D level with nonspecific musculoskeletal pain while adjusting for clinically relevant covariates. Results Among these 414 patients, mean (SD) 25(OH)D level was 29 (12) ng/mL, and 30% had nonspecific musculoskeletal pain. After adjustment for age, sex, race, body mass index, Functional Independence Measure score, Deyo-Charlson Comorbidity Index, fractures, steroid use, history of osteoporosis/osteomalacia, and patient type (orthopedic, cardiac, neurological, spinal cord injury, or traumatic brain injury), serum 25(OH)D level was inversely associated with nonspecific musculoskeletal pain (odds ratio [OR] per 10 ng/mL, 0.67; 95% confidence interval [CI], 0.48–0.82). When 25(OH)D level was dichotomized, patients with levels <20 ng/mL had higher odds of nonspecific musculoskeletal pain (OR, 2.33; 95% CI, 1.23–4.17) compared with patients with levels ≥20 ng/mL. Conclusions In adult patients, serum 25(OH)D level on admission to ARU was inversely associated with nonspecific musculoskeletal pain. These data support the need for randomized, controlled trials to test the role of vitamin D supplementation to improve nonspecific musculoskeletal pain in ARU patients.

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“…Once individuals are transferred from acute care to a rehabilitation setting, pain may persist. For example, 40% to 50% of individuals hospitalized for stroke rehabilitation report pain, 82% of those hospitalized for postsurgical orthopedic rehabilitation complain of at least moderate pain, and 97% of those hospitalized for rehabilitation after acute traumatic spinal cord injury report pain at least once during the rehabilitation stay . Less is known about the incidence of persistent pain (lasting >3 months) after postacute rehabilitation, but it could be as high as 50% after rehabilitation for surgical interventions .…”

mentioning

confidence: 99%

“…Some of these predictors include older age, cognitive impairment, pre‐illness dependence in personal care activities, depression, sleep disturbances, lack of family involvement, fewer hours of physical therapy during rehabilitation, and fear of falling . Pain has been described as an immediate and long‐term predictor of poorer functional recovery at discharge from rehabilitation units as well . Previous research has evaluated the impact of pain in the acute care setting (e.g., the role of post‐operative pain) .…”

mentioning

confidence: 99%

Association Between Pain and Functional Independence in Older Adults During and After Admission to Rehabilitation After an Acute Illness or Injury

Rodrı́guez

Dzierzewski

Fung

et al. 2015

J American Geriatrics Society

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OBJECTIVES To investigate the association between pain and functional independence in older adults during and after admission to rehabilitation after an acute illness or injury. DESIGN Prospective, observational cohort study. SETTING One community and one Veterans Affairs rehabilitation center. PARTICIPANTS Individuals aged 65 and older admitted for rehabilitation after an acute illness or injury (postacute rehabilitation) (N = 245; mean age 80.6, 72% male)). MEASUREMENTS Pain was assessed using the Geriatric Pain Measure (GPM, score 0–100). Functional independence was measured using the motor component of the Functional Independence Measure (mFIM, score 13–91). Both scores were obtained at admission; discharge; and 3-, 6-, and 9-month follow-up. In bivariate analyses, discharge GPM and persistent pain (lasting >3 months) were evaluated as predictors of mFIM score at 9 months. Applying a multilevel modeling (MLM) approach, individual deviations in GPM scores were used to predict variations in mFIM. RESULTS At admission, 210 participants (87.9%) reported pain (16.3% mild (GPM<30); 49.3% moderate (GPM: 30–69); 22.1% severe (GPM>70)); 21.3% reported persistent pain after discharge. The bivariate analyses did not find statistically significant associations between discharge GPM or persistent pain and mFIM score at 9 months, but in the MLM analysis, deviations in GPM were significant predictors of deviations in mFIM score, suggesting that, when individuals experienced above-average levels of pain (GPM > their personal mean GPM), they also experienced worse functional independence (mFIM < their personal mean mFIM). CONCLUSION Twenty-one percent of older adults undergoing postacute rehabilitation reported persistent pain after discharge from rehabilitation. The bivariate analysis did not find association between pain and functional independence, but MLM analysis showed that, when participants experienced more pain than their average, they had less functional independence.

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Pain and Its Impact on Inpatient Rehabilitation for Acute Traumatic Spinal Cord Injury: Analysis of Observational Data Collected in the SCIRehab Study

Cited by 28 publications

References 32 publications

Depression, Pain Intensity, and Interference in Acute Spinal Cord Injury

Depression, Pain Intensity, and Interference in Acute Spinal Cord Injury

Association Between Serum 25(OH)D Level and Nonspecific Musculoskeletal Pain in Acute Rehabilitation Unit Patients

Association Between Pain and Functional Independence in Older Adults During and After Admission to Rehabilitation After an Acute Illness or Injury

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