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Riley BB. Wallbom A. Tate DG. Prediction of Neuropathic Pain One Year After Discharge Among Persons with Spinal Cord Injury.
Abstract
STUDY DESIGN: A longitudinal study. OBJECTIVES: The aim of the present study is to identify predictors of subsequent/chronic neuropathic pain among persons with spinal cord injury (SCI). It was hypothesized that neuropathic pain at follow-up will be significantly predicted by: (1) violence as the cause of injury, (2) incomplete and/or paraplegic level of injury, (3) increasing age, (4) psychological distress, (5) increased functional independence, and (6) pain status at discharge. A longitudinal design was employed in which at-level, below-level, and combined-level NPS at one year follow-up was predicted. SETTING: Participants were 362 hospital inpatients with SCI who volunteered to participate in a SCI Model Systems research project, located in a Midwestern medical center in the United States. METHODS: Ratings on the Functional Independence Measure, (FIM) psychological diagnoses, neurological level, age, physician-assessed pain at discharge and demographic variables were used to predict neuropathic pain status at on-year post-discharge. RESULTS: Logistic regression analyses revealed that at-level NPS at follow-up was significantly predicted by Social Cognition and Locomotion FIM subscales, discharge at-level NPS, neurological level of injury, cause of SCI, and occupational status. Social Cognition was the single best predictor of at-level NPS (p<.01). Only self-reported pain at discharge significantly predicted below-level NPS at follow-up; musculoskeletal pain, at-level and below-level NPS at discharge being significant predictors. For the combined-level model of NPS, Social Cognition, Communication, (FIM) discharge at-level NPS, cause of SCI, employment and neurological level were significant predictors. Social Cognition was the single best predictor of neuropathic pain at or below the level of injury. Correct classification rates were 76, 79.9, and 69 percent for at-level, below-level, and combined-level NPS, respectively. For the three models, sensitivity rates ranged from 10.0 to 38.0 percent, whereas specificity rates ranged from 89.3 to 92.5 percent. CONCLUSIONS: These findings suggest that functional ability, severity of neurological impairment, as well as demographic variables can serve as early indicators of subsequent neuropathic pain. KEYWORDS: neuropathic pain, spinal cord injury, functional independence, level of injury, cause of SCI, psychological distress.