title: Pain severity and mobility one year after spinal cord injury: a multicenter, cross-sectional study.
abstract: Following a spinal cord injury, patients are often burdened by chronic pain. Preliminary research points to activation of the motor cortex through increased mobility as a potential means of alleviating postinjury chronic pain.
  
  
  
  The aim of this study was to assess the relationship between pain severity and mobility among patients who have sustained a traumatic spinal cord injury while controlling for clinically-relevant covariates.
  
  
  
  A multi-center, cross-sectional study.
  
  
  
  The SCIMS is composed of 14 centers, all located in the United States and funded by the National Institute on Disability and Rehabilitation Research (NIDRR).
  
  
  
  The study cohort included 1980 patients who completed the one-year SCIMS follow-up assessment between October 2000- December 2013.
  
  
  
  A multi-center, cross-sectional study was performed to assess the impact of mobility on self-reported pain using information from 1980 subjects who sustained a traumatic spinal cord injury and completed a year-one follow-up interview between October 2000 and December 2013. Patient information was acquired using the Spinal Cord Injury National Database, compiled by the affiliated Spinal Cord Injury Model Systems. Analyses included a multivariable linear regression of patients' self-reported pain scores on mobility, quantified using the CHART-SF mobility total score, and other clinically relevant covariates.
  
  
  
  After controlling for potential confounders, a significant quadratic relationship between mobility and patients' self-reported pain was observed (P=0.016). Furthermore, female gender, "unemployed" occupational status, paraplegia, and the presence of depressive symptoms were associated with significantly higher pain scores (P<0.02 for all variables). Statistically significant quadratic associations between pain scores and age at injury, life satisfaction total score, and the CHART-SF occupational total subscale were also observed (P≤0.03 for all variables).
  
  
  
  Among patients with moderate to high levels of mobility, pain scores decreased with increasing mobility.
  
  
  
  Enhancing a patient's physical activity by increasing his or her mobility may reduce neuropathic pain if begun shortly after a spinal cord injury.
authors.affiliation: Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA - felipe.fregni@ppcr.hms.harvard.edu.
authors.forename: Bianca F
authors.initials: BF
authors.lastname: Marcondes
authors.affiliation: Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA
authors.forename: Shruti
authors.initials: S
authors.lastname: Sreepathi
authors.affiliation: Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA
authors.forename: Justin
authors.initials: J
authors.lastname: Markowski
authors.affiliation: Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA
authors.forename: Dung
authors.initials: D
authors.lastname: Nguyen
authors.affiliation: Department of Mathematics and Computer Science, College of the Holy Cross, Worcester, MA, USA
authors.forename: Shannon R
authors.initials: SR
authors.lastname: Stock
authors.affiliation: Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA - felipe.fregni@ppcr.hms.harvard.edu.|Neuropsychophysiology Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
authors.forename: Sandra
authors.initials: S
authors.lastname: Carvalho
authors.affiliation: University of Michigan Spinal Cord Injury Model System, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
authors.forename: Denise
authors.initials: D
authors.lastname: Tate
authors.affiliation: Spaulding-Harvard Spinal Cord Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA|Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
authors.forename: Ross
authors.initials: R
authors.lastname: Zafonte
authors.affiliation: Spaulding-Harvard Spinal Cord Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA|Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Morse
authors.affiliation: Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA - felipe.fregni@ppcr.hms.harvard.edu.|Spaulding-Harvard Spinal Cord Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009437:Neuralgia / Q000503:physiopathology / Q000534:rehabilitation*; D010147:Pain Measurement; D010264:Paraplegia / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D011782:Quadriplegia / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States