title: Patterns of pain across the acute SCI rehabilitation stay: evidence from hourly ratings.
abstract: METHODS
  Cohort.
  
  
  OBJECTIVE
  To examine patterns of pain intensity and variability during acute spinal cord injury (SCI) rehabilitation.
  
  
  METHODS
  Large medical university in the Midwestern United States.
  
  
  METHODS
  Data were collected from the medical records of consecutively admitted patients with new (< or =2 months after onset), traumatic (that is, injury resulting from external forces) or non-traumatic (that is, injury resulting from disease processes) SCI. A total of 11,001 hourly pain ratings on 1709 inpatient days were collected from 56 inpatients. Multi-leveling modeling was used to test models of pain intensity, pain variability, diurnal variability and pain medication administration.
  
  
  RESULTS
  Pain intensity and variability decreased during the inpatient stay. Compared with those with non-traumatic injuries, those with traumatic injuries had significantly higher pain; those with American Spinal Injury Association Impairment Score (AIS) A scores had a slower decline of pain, while those with AIS D scores had a sharper decline. Pain increased from morning to evening during the latter days of the inpatient stay whereas pain was relatively stable during the early days in the inpatient stay. Those not using a ventilator at admission were significantly less likely to receive a pain medication than those who were, despite no significant differences in pain levels.
  
  
  CONCLUSIONS
  Pain changes during acute rehabilitation, however, the moderating effect of time suggests that change is not consistent across all injury characteristics. Findings suggest that not only should pain management be individualized but it should also reflect a greater understanding of change over time.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108-5744, USA. clairez@umich.edu
authors.forename: C Z
authors.initials: CZ
authors.lastname: Kalpakjian
authors.forename: P E
authors.initials: PE
authors.lastname: Khoury
authors.forename: A E
authors.initials: AE
authors.lastname: Chiodo
authors.forename: A L
authors.initials: AL
authors.lastname: Kratz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010146:Pain / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D010147:Pain Measurement; D013119:Spinal Cord Injuries / Q000150:complications / Q000523:psychology / Q000534:rehabilitation; D013997:Time Factors; D014481:United States; D055815:Young Adult