The influence of pain on community reintegration after spinal cord injury.

Background

Community reintegration is an important goal for people living with a spinal cord injury (SCI), and pain is suspected to limit reintegration due to its limitations in daily functioning, mood, and sleep.

Objectives

To determine the influence of pain on community reintegration in manual wheelchair users with SCI.

Methods

The Reintegration to Normal Living Index was used to determine community reintegration, while the DN4 and the Wheelchair User's Shoulder Pain Index were used to determine the presence of neuropathic and shoulder pain respectively. Associations and differences between the pain variables and participants with and without pain were analyzed with Spearman correlations and Mann-Whitney U-tests using SPSS v27 at 0.05 significance level and 95% confidence interval.

Results

Of the 122 participants, 85.2% reported current pain, with a 77.7% median for community reintegration. Neuropathic pain (53.3%) was more common and severe than nociceptive shoulder pain (14.8%). There was no significant difference in community reintegration between participants with and without pain, nor any correlation between the overall presence of pain and community reintegration. The severity of pain, particularly shoulder pain, was negatively associated with taking trips out of town (p < 0.01), and overall community reintegration (p < 0.05).

Conclusion

It is not the mere presence of pain that influences community reintegration, but rather the severity and the location of pain. Shoulder care and pain management need to be included in the rehabilitation program, as these are important considerations when rehabilitating people with SCI back into their communities.

References:

• Jensen MP, Truitt AR, Schomer KG, Yorkston KM, Baylor C, Molton IR. Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review. Spinal Cord. 2013;51(12):882–892.
• Pilusa SI, Myezwa H, Potterton J. Experiences of secondary health conditions amongst people with spinal cord injury in South Africa: a qualitative study. S Afr J Physiother. 2021;77(1):a1530. https://doi.org/10.4102/sajp.v77i1.1530
• Hadjipavlou G, Cortese AM, Ramaswamy B. Spinal cord injury and chronic pain. Br J Anaesth Educ. 2016;16(8):264–268.
• Jang JY, Lee SH, Kim MY, Ryu JS. Characteristics of neuropathic pain in patients with spinal cord injury. Ann Rehabil Med. 2014;38(3):327–334.
• Mashola MK, Mothabeng DJ. Associations between health behaviour, secondary health conditions and quality of life in people with spinal cord injury. Afr J Disabil. 2019;8:463.