Pain Trajectories in the First Year After Spinal Cord Injury

Research Objectives: (1) To assess patterns of persistence or resolution of individual pain problems identified among people with traumatic spinal cord injury (SCI) in the first year post injury. (2) To characterize pain trajectories within subtypes of SCI pain defined by the International SCI Pain Basic Data Set (ISCIPBDS) in a sample of individuals assessed in the first year after traumatic SCI.

Design: Analysis of a subset of data from a longitudinal observational study of pain development in the first year post traumatic SCI. Participant interviews were conducted by SCI professionals experienced in pain classification during inpatient rehabilitation (E1), 6 months post-injury (E2), and 12 months post-injury (E3).

Setting: Initiated in inpatient rehabilitation with longitudinal follow-up post-discharge for 12 months.

Participants: 28 adults with new, traumatic SCI who were able to complete pain interviews in English and had known pain statuses for all three timepoints.

Interventions: Not applicable (observational study)

Main Outcome Measures: Pains were classified (nociceptive, neuropathic, other) according to the ISCIPBDS. Pain name, location, classification, and interviewer notes on relation to previously reported pains were used to identify each pain problem across time. Pain trajectories were classified in 5 categories based on timing of onset or resolution at each timepoint: persistent (present at E1, E2, E3), resolving (not present at E3), returning (E1, E3), transient (E2 only), delayed onset (present at E2 and/or E3 only).

Results: Of the 28 participants with known pain status, 1 reported no pain at any timepoint. Among the remaining 27 participants, 108 total pains were reported, of which 34% were neuropathic and 66% were nociceptive. The most common pain trajectories among all pains were resolving and delayed onset (34% each), followed by persistent (20%), transient (10%), and returning (2%). The most common pain trajectories by pain classification were delayed onset (35%) for neuropathic pains and resolving (41%) for nociceptive pains.

Conclusions: The majority of observational studies of pain among people with SCI are cross-sectional, creating a need for further information on pain trajectories over time. Pain problems among those with SCI follow a variety of trajectories, with patterns differing between neuropathic and nociceptive pains. Further analyses will be conducted to identify sensory, injury, and/or psychosocial characteristics associated with pain trajectory to inform prognosis.

Author(s) Disclosures: None