title: Effects of Pain and Pain Management on Motor Recovery of Spinal Cord-Injured Patients: A Longitudinal Study.
abstract: Background Approximately 60% of patients suffering from acute spinal cord injury (SCI) develop pain within days to weeks after injury, which ultimately persists into chronic stages. To date, the consequences of pain after SCI have been largely examined in terms of interfering with quality of life. Objective The objective of this study was to examine the effects of pain and pain management on neurological recovery after SCI. Methods We analyzed clinical data in a prospective multicenter observational cohort study in patients with SCI. Using mixed effects regression techniques, total motor and sensory scores were modelled at 1, 3, 6, and 12 months postinjury. Results A total of 225 individuals were included in the study (mean age: 45.8 ± 18 years, 80% male). At 1 month postinjury, 28% of individuals with SCI reported at- or below-level neuropathic pain. While pain classification showed no effect on neurological outcomes, individuals administered anticonvulsant medications at 1 month postinjury showed significant reductions in pain intensity (2 points over 1 year; P < .05) and greater recovery in total motor scores (7.3 points over 1 year; P < .05). This drug effect on motor recovery remained significant after adjustment for injury level and injury severity, pain classification, and pain intensity. Conclusion While initial pain classification and intensity did not reveal an effect on motor recovery following acute SCI, anticonvulsants conferred a significant beneficial effect on motor outcomes. Early intervention with anticonvulsants may have effects beyond pain management and warrant further studies to evaluate the therapeutic effectiveness in human SCI.
authors.affiliation: International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jacquelyn J
authors.initials: JJ
authors.lastname: Cragg
authors.affiliation: Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, CA, USA.
authors.forename: Jenny
authors.initials: J
authors.lastname: Haefeli
authors.affiliation: University Hospital Balgrist, Zurich, Switzerland.
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Jutzeler
authors.affiliation: Berufsgenossenschaftliche Klinik Bergmanstrost of Halle, Halle, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Röhrich
authors.affiliation: Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Weidner
authors.affiliation: Orthopädische Klinik, Hessisch Lichtenau, Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Saur
authors.affiliation: Berufsgenossenschaftliche Klinik, Murnau, Germany.
authors.forename: Doris D
authors.initials: DD
authors.lastname: Maier
authors.affiliation: RKU Universitäts und Rehabilitationskliniken Ulm, Ulm, Germany.
authors.forename: Yorck B
authors.initials: YB
authors.lastname: Kalke
authors.affiliation: Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schuld
authors.affiliation: University Hospital Balgrist, Zurich, Switzerland.
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
authors.affiliation: International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada kramer@icord.org.
authors.forename: John K
authors.initials: JK
authors.lastname: Kramer
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology* / Q000534:rehabilitation; D010146:Pain / Q000209:etiology*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D020127:Recovery of Function / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome
keywords: NSAIDs; gabapentin; pregabalin; spinal cord injury; spontaneous recovery