Journal of Rehabilitation Medicine 51-7 | Page 37
J Rehabil Med 2019; 51: 506–512
ORIGINAL REPORT
PAIN CORRELATES WITH SOCIAL INTEGRATION IN INDIVIDUALS WITH
TRAUMATIC SPINAL CORD INJURY: A CROSS-SECTIONAL SURVEY
Wang DAWU, MD, PhD 1 , He CHAO, BS 2 , Li KAITING, MM 1 , Shao LAN, MD, PhD 1 , Peng XIAOHUA, MD, PhD 1 and Bai
DINGQUN, MD, PhD 1
From the 1 Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University and 2 Department of
Acupuncture and Moxibustion, The Chinese Traditional, Medicine Hospital of Beibei District, Beibei District, Chongqing, China
Objective: To describe the relationship between pain
and social integration following spinal cord injury
using comprehensive evaluation of pain-related
clinical characteristics and different aspects of so-
cial integration.
Design: A cross-sectional study.
Participants: A total of 318 participants with Ameri-
can Spinal Cord Injury Association Impairment Scale
(AIS) Grades A, B, C or D and > 3 months post-injury.
Methods: All participants completed the survey rela-
ting to demographics, pain characteristics, and the
Craig Handicap Assessment Reporting Technique So-
cial Integration scores.
Results: Individuals who were younger, those 3–6
years after injury, and those with a grade of AIS gra-
de A (odds ratio (OR) 8.32, 95% confidence interval
(95% CI) 1.83–12.07) or B (OR 3.25, 95% CI 0.91–
7.63) were more likely to report neuropathic pain.
Significant inverse correlations were found between
pain intensity and social integration (R
=
–0.597,
p = 0.019). Brief Pain Inventory interference scores
were negatively associated with 5 (friends, living si-
tuation, business, strangers and family) of 6 domains
of Craig Handicap Assessment Reporting Technique
social integration (p < 0.001). Pain type and only one
domain (strangers) showed a significant negative
relationship (B=–1.47, p = 0.02).
Conclusion: Chronic pain after spinal cord injury is
negatively associated with Craig Handicap Assess-
ment Reporting Technique social integration. Brief
Pain Inventory Pain interference, to a greater extent
than pain type, best predicts social integration after
spinal cord injury.
Key words: spinal cord injury; pain; social integration; neu-
ropathic pain; nociceptive pain.
Accepted May 10, 2019; Epub ahead of print May 23, 2019
J Rehabil Med 2019; 51: 506–512
Correspondence address: Bai Dingqun, Department of Rehabilitation
Medicine, The First Affiliated Hospital of Chongqing Medical Univer-
sity, 1 You-Yi Road, Chongqing 400016, China. E-mail: 470811233@
qq.com
P
ain is a common, and sometimes severe, complica-
tion of spinal cord injury (SCI) (1, 2). A number
of studies have investigated the prevalence of chronic
pain following SCI, and most indicate a prevalence
of approximately 65%. Furthermore, after SCI, many
individuals have severe pain, with approximately
LAY ABSTRACT
After spinal cord injury, pain is a common and someti-
mes severe complication. Social integration has been
linked to positive outcomes including better physical
health. This study aimed at exploring the association
between pain and social integration post-spinal cord
injury. Our results showed that those with neuropathic
pain presented more severe pain. The presence of pain
negatively impacted social integration post injury. Pain
interference was the best pain item to predict social in-
tegration in those who reported pain.
one-third of people describing the pain as severe or
excruciating (3, 4). The pain tends to persist, and even
worsen, with time, especially if it begins within 6
months after injury. Despite numerous classifications
proposed, there is no single widely accepted scheme
for SCI pain. The main classifications include the
International Spinal Cord Injury Pain and Cardenas
classifications (5, 6). Most subjects after SCI share 2
basic categories of pain: nociceptive and neuropathic.
Pain takes a toll on an individual’s activity levels
and mental health status, reducing their quality of life
(QoL). Chronic pain is associated with poorer psy-
chological functioning and lower QoL (7–10). Social
integration is an important factor for health-related
QoL after critical illness (11). The role of social rela-
tionships, especially integration, has been emphasized
as a buffer against negative health effects and, further-
more, it is argued that social integration maintains or
sustains the organism by promoting adaptive behaviour
of neuroendocrine responses in the face of stress or
other health hazards. More socially isolated or less
socially integrated individuals are less healthy, both
psychologically and physically (11).
Some studies have evaluated pain patterns, com-
plaints, and the associations with QoL in individuals
with SCI (7–9). However, to date, few studies have
examined the association between chronic pain and
social integration after SCI. The purpose of the current
study was to determine: (i) the percentage of persons
with pain; (ii) the demographics of individuals with
pain; and (iii) the relationship between pain and so-
cial integration in a sample of participants with SCI.
It was hypothesized that individuals with SCI would
commonly experience pain and that pain interference
would be associated with lower social integration.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
doi: 10.2340/16501977-2565
Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977