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Gender and minority differences in the pain experience of people with spinal cord injury1,

https://doi.org/10.1016/j.apmr.2004.04.027Get rights and content

Abstract

Cardenas DD, Bryce TN, Shem K, Richards JS, Elhefni H. Gender and minority differences in the pain experience of people with spinal cord injury. Arch Phys Med Rehabil 2004;85:1774–81.

Objectives

To examine gender and minority differences in the prevalence and severity of pain in people with traumatic-onset spinal cord injury (SCI) during follow-up, and to determine the relation of those differences to demographic characteristics, etiology of injury, and level and extent of the lesion.

Design

Survey and analysis of cross-sectional data using case-control methodology and multiple regression methods.

Setting

Model Spinal Cord Injury Systems (MSCIS).

Participants

A total of 7379 individuals with traumatic-onset SCI from 16 MSCIS entered in the National Spinal Cord Injury Statistical Center database between 1998 and 2002.

Interventions

Not applicable.

Main outcome measures

Prevalence and severity of pain as reported in follow-up surveys.

Results

Pain prevalence remained fairly stable over time, ranging from 81% at 1 year postinjury to 82.7% at 25 years. Pain was no more common in women than in men, nor did pain severity scores differ significantly. However, pain prevalence was significantly lower among nonwhites, although they tended to report a higher average pain severity score when pain was present. Also, people with SCI who were employed when injured, who had more than a high school education, and who were not tetraplegic reported a higher prevalence of pain. Pain interfered with work more often for women and nonwhites during some, but not all, follow-up years, and for those who were not employed at the time of interview, for those whose SCI was caused by violence, for those with paraplegia, and for those with incomplete SCI.

Conclusions

Pain is a common and significant problem for the majority of people with SCI. It may interfere less frequently with work over time, which suggests that an adaptive process may be occurring. Gender differences in the pain experience did not emerge, but nonwhites tended to have a lower prevalence of pain. If pain was present, nonwhites tended to report more severe pain than did whites. Further research is needed to delineate the possible psychosocial and biomedical causes of these findings.

Section snippets

Methods

People with traumatic-onset SCI who are in the NSCISC database are treated currently in 16 geographically dispersed MSCIS in the United States. The gender distribution of that database since its inception has been a 4:1 male to female ratio. The race distribution is currently as follows: white, 67.4%; African American, 21.8%; other, 1.1%; Asian, 1.5%; American Indian, 1%; and 7.2% coded “unknown.” Data were extracted for people with SCI who had responded to questions about pain severity and the

Results

There were 7379 cases in the database with at least some pain data at 1 of the 6 follow-up years. Subjects with incomplete data for the variables used in this analysis were excluded (see fig 1 for a review of recruitment and attrition for the samples used). Subjects with and without available pain data were compared. There was no statistically significant difference in the percentage of women or in the rate of complete injury between the 2 groups.

However, there was a significant difference in

Overall prevalence

The overall 80.5% prevalence of pain found in this sample of people with traumatic SCI—the largest yet reported—is similar to or greater than that found by most others, including all of the studies with the largest previously reported samples.3, 31, 32 The overall prevalence of pain in the other samples were (1) 66% for pain and distressing dysesthesias in 901 consecutive inpatients or outpatients at 4 SCI centers in Germany3; (2) 82% for a persistent, bothersome pain problem in a postal survey

Conclusions

Pain is a common and significant problem for people with SCI. Our data suggest that the prevalence of pain is substantial (80% of people with SCI report pain) and stable over time, as is average reported pain severity. Pain appears to interfere less frequently with work over time, however, which suggests that an adaptive process may occur. That inference can only be truly verified, however, by a longitudinal analysis, not the cross-sectional analysis to which we were limited in this study.

References (52)

  • R.B. Fillingim et al.

    Sex-related hormonal influences on pain and analgesic responses

    Neurosci Biobehav Rev

    (2000)
  • R.M. Craft

    Sex differences in drug- and non-drug-induced analgesia

    Life Sci

    (2003)
  • J.A. Turner et al.

    Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury

    Pain

    (2002)
  • D.H. Rintala et al.

    Chronic pain in a community-based sample of men with spinal cord injuryprevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being

    Arch Phys Med Rehabil

    (1998)
  • P.J. Siddall et al.

    Pain report and the relationship of pain to physical factors in the first 6 months following spinal cord injury

    Pain

    (1999)
  • G. Davidoff et al.

    Trazodone hydrochloride in the treatment of dysesthetic pain in traumatic myelopathya randomized, double-blind, placebo-controlled study

    Pain

    (1987)
  • J.J. Bonica

    Introductionsemantic, epidemiologic, and educational issues

  • S. Stormer et al.

    Chronic pain/dysesthesiae in spinal cord injury patientsresults of a multicare study

    Spinal Cord

    (1997)
  • C. Nepomuceno et al.

    Pain in patients with spinal cord injuries

    Arch Phys Med Rehabil

    (1979)
  • Final reportthe PVA needs assessment survey

    (1988)
  • J.S. Richards et al.

    Pain management

    Top Spinal Cord Inj Rehabil

    (2001)
  • A.G. Anke et al.

    Pain and life quality within two years of spinal cord injury

    Paraplegia

    (1995)
  • G. Demirel et al.

    Pain following spinal cord injury

    Spinal Cord

    (1998)
  • P. Fenollosa et al.

    Chronic pain in the spinal cord injuredstatistical approach and pharmacological treatment

    Paraplegia

    (1993)
  • J.A. Turner et al.

    Chronic pain problems in individuals with spinal cord injuries

    Semin Clin Neuropsychiatry

    (1999)
  • R. Levi et al.

    The Stockholm spinal cord injury study: 2. Associations between clinical patient characteristics and post-acute medical problems

    Paraplegia

    (1995)
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    Supported by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitation Services, US Department of Education (grant no. H133N000003) and the National Institute of Diabetes and Digestive and Kidney Diseases (grant no. DK51413).

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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