Pain and social integration after spinal cord injury
use of the spinal column, as well as chronic muscular
pain secondary to postural abnormalities and overuse
syndromes.
Participants with pain DN4 score ≥ 3, which suggests
the presence of NP, reported higher pain intensity and
pain interference and had a lower satisfaction with
their life situation and mental health than those with
pain and a DN4 score < 3. Burning (79%), pins and
needles (76%) and tingling (71%) were the most com-
mon pain descriptors.
A previous study reported that individuals with an
AIS grade of B experienced more intense NP than
those with other grades (9). A relationship between
completeness of injury and prevalence of pain was also
reported previously (21). In contrast, our study found
that individuals with AIS grades A and B showed a trend
to more NP than individuals with other AIS grades.
The reason why individuals with AIS grades A and B
had the greatest pain in our study seems to be because
there are several proposed mechanisms for the origin
of NP after SCI. Pain may arise from a combination of
generators: peripheral, spinal, and supra-spinal (22).
Peripheral sources may include impingement of nerve
roots, resulting in radicular-at-level NP. Spinal pain may
be due to an “irritated focus” or “neural pain generator”
located at the injury site, as there are cases of spinal
blockade with anaesthetics abolishing pain (22).
Many studies have examined the association of
chronic pain after SCI with QoL (8, 10, 19, 23). Sig-
nificantly poorer QoL was observed in the NP group in
comparison with those reporting no pain or nociceptive
pain. Individuals with moderate to significant chronic
pain participate less, are more restricted in, and less
satisfied with, participation, and have higher levels of
depressive symptoms, and lower QoL than individuals
with no or mild chronic pain (10).
This study conducted qualitative analysis to examine
the relationship between chronic pain and social integra-
tion in individuals with SCI. These analyses suggested
that chronic pain is negatively associated with social
integration among participants with SCI. Furthermore,
we found that pain interference can act as predictor of
CHART social integration. Pang et al. (24) also sho-
wed that pain interference and depressive symptoms
are significantly associated with disease management
self-efficacy in people with SCI. These findings are im-
portant and add to our understanding of the relationship
between chronic pain and social integration after SCI.
More importance should be attached to the mana-
gement of pain after SCI. Clinicians should raise the
awareness of pain and ensure early detection, diagnosis
and treatment, in order to reduce adverse effects on
QoL and social integration in individuals with SCI.
Secondly, implementing enhanced patient education
511
is necessary to improve the prognosis of pain post-
SCI, and to maximize efficiency of health care for the
physician and the patient. Finally, individuals with SCI
are at risk of poor outcomes in terms of social integra-
tion. Lack of social support is a barrier to good mental
health. There is a need for tailored health promotion
initiatives in the everyday lives of individuals with SCI.
The CHART Social Integration subscale score was
used in this analysis. This score employed 6 questions
to quantify the extent to which individuals fulfil various
social roles. In the initial CHART social integration
questionnaire the frequency of keeping in touch with
friends, business and family was reported as instances
per month, and with strangers as instances in the pre-
ceding month. However, we modified these intervals by
the substitution of once every 2 weeks, and in the pre-
ceding 2 weeks for once a month, preceding 2 weeks,
respectively. This modification was made because the
current information age is significantly different from
when the CHART was initially developed; interperso-
nal contacts and exchanges are increasingly frequent.
The main limitation of the present study is the small
size of the samples and relatively short duration (the
majority ≤ 6 years) after SCI. This could have led
to a slight bias in the analysis of the pain and social
integration scores. This study is based mainly on ques-
tionnaires. Self-reporting is always accompanied by
the possibility that some individuals provided inac-
curate answers. In addition, the current study was not
extended to assess effect of at-level and below-level
NP on social integration.
In conclusion, individuals with NP presented more
severe pain than those with nociceptive pain. The pre-
sence of pain impacted negatively on social integration
after injury. Pain interference was the best pain item to
predict social integration in those who reported pain.
ACKNOWLEDGEMENTS
The authors thank all individuals who participated in the study.
We would also thank the following persons who contributed
to participant recruitment and data collection: Hao Jie, Shen
Jieliang, Hu Zhenming (Department of Orthopedic Surgery,
The First Affiliated Hospital of Chongqing Medical University).
The authors have no conflicts of interest to declare.
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