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

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.

Keywords: Latent class analysis; Longitudinal Studies; Mental Health; Pain; Pain management; Psychology, Positive; Rehabilitation; Spinal Cord Injuries.