title: Psychosocial aspects of spinal cord injury pain: a meta-analysis.
abstract: METHODS
  Meta-analysis.
  
  
  OBJECTIVE
  Although the association between modifiable psychosocial factors and spinal cord injury (SCI) pain has been identified, the full range of psychological and social difficulties for those who experience acute and/or persistent pain remains unclear. This meta-analysis consolidates the available evidence, using the International Classification of Functioning, Disability and Health (ICF) as a reference framework.
  
  
  METHODS
  Nineteen studies that examined persistent neuropathic, nociceptive or mixed pain subtypes in adults with a SCI (newly acquired and chronic; Nparticipants=2934) were identified from electronic database searches. Standardised mean differences between SCI pain and no-pain groups on self-reported psychosocial outcomes were calculated, along with 95% confidence intervals, fail-safe Ns and heterogeneity statistics.
  
  
  RESULTS
  Twenty individual outcomes were grouped into nine ICF-related categories. Emotional functions were the most frequent (100%) psychosocial outcomes assessed, with pain contributing to heightened stress (d=-0.85), depression (d=-2.49) anxiety (d range=-0.85 to -1.45), poor self-efficacy (d=-0.77), lowered wellbeing (d range=-0.67 to -1.02) and decreased use of adaptive coping, such as illness acceptance (d=-0.85). Activity limitations and participation restriction were examined by seven studies (43%), although these findings were largely characterised by single studies.
  
  
  CONCLUSIONS
  Multicomponent treatments that target mood disturbance and foster community connections are important in SCI pain management. However, to improve the comparability of future studies, SCI pain research must adopt definitions of pain consistent with the International Spinal Cord Injury Pain Classification along with validated outcomes that map onto the ICF framework.
authors.affiliation: School of Psychology, University of Adelaide, Adelaide, SA, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Tran
authors.affiliation: School of Psychology, University of Adelaide, Adelaide, SA, Australia.
authors.forename: D S
authors.initials: DS
authors.lastname: Dorstyn
authors.affiliation: School of Psychology, University of Adelaide, Adelaide, SA, Australia.|Psychology Department, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: A L J
authors.initials: AL
authors.lastname: Burke
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D019964:Mood Disorders / Q000209:etiology; D010146:Pain / Q000150:complications / Q000209:etiology* / Q000523:psychology*; D059408:Pain Management; D013119:Spinal Cord Injuries / Q000150:complications*