Depression and pain among inpatients with spinal cord injury and spinal cord disease: differences in symptoms and neurological function

Abstract

Purpose: To examine the relationship between depression and pain severity during inpatient rehabilitation for those with new onset of spinal cord injury or spinal cord disease (SCI/D), along with patient characteristics, neurological function and etiology. Method: This cross-sectional study reviewed medical records of 100 adults with SCI/D including their admission scores on the Patient Health Questionnaire 9 (PHQ-9), a measure of depression, and pain ratings collected at admission and discharge. Results: Upon admission, 28% reported moderate-to-severe symptoms of depression and 69% reported pain. PHQ-9 scores were associated with pain only among those with the least severe impairments, for whom higher scores were associated with greater pain. While depression levels did not differ by etiology, those with traumatic injuries had higher pain ratings. Conclusions: In general, depressive symptoms were not associated with pain severity in this sample. Etiology was associated with pain, those with traumatic SCI reporting more pain at admission. Among demographic characteristics, age was related to pain, with younger subjects reporting higher levels. These findings suggest that certain characteristics may predispose patients to pain and depression upon admission to rehabilitation. By determining who is at risk for these symptoms, clinicians can adopt treatments that prevent these from becoming chronic conditions.

Implications for Rehabilitation

• Depression and pain are often discussed as common symptoms following the onset of spinal cord injury (SCI); however, not everyone who has pain will exhibit depression.

• Among those with incomplete injuries (AIS D) severity of symptoms seem to be related with those experiencing moderate to severe pain also showing signs of depression.

• Etiology was found to be a correlate of pain. Those with traumatic SCI experience greater pain than do those with non-traumatic etiologies of SCI.

• Having ways to identify which patients will most likely experience these symptoms upon admission to rehabilitation can help guide early interventions to prevent secondary complications of pain and depression.

Keywords::

• Depression
• pain
• spinal cord disease
• spinal cord injury
• traumatic and non-traumatic injuries

Acknowledgments

The authors wish to thank Jane Walters MSW, former Data Collection Coordinator for the University of Michigan SCI Model System and Carrie Pilarski PhD., a Rehabilitation Psychologist at Origami Brain Injury Rehabilitation, for their assistance in both data collection and entry for this project.

Declaration of Interest: This work was funded in part by two awards from the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, US Department of Education: Award Numbers H133N060032 and H133P030004. This work was also funded by Award Number T32HD007422-19 from the National Center for Medical Rehabilitation Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Disability and Rehabilitation Research and the National Center for Medical Rehabilitation Research.