Journal of Rehabilitation Medicine 51-7

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

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