Psychological morbidity following spinal cord injury and among those without spinal cord injury: the impact of chronic centralized and neuropathic pain

Spinal Cord, 2022 · DOI: 10.1038/s41393-021-00731-4 · Published: February 1, 2022

Spinal Cord Injury Mental Health Pain Management

Simple Explanation

This study looks at the risk of psychological issues in adults with spinal cord injuries (SCI) compared to those without SCI. The study also looks at how chronic pain affects the risk of psychological issues in both groups. Researchers analyzed a large insurance claims database to compare the incidence of psychological conditions over time.

Study Duration

5 Years

Participants

9,081 adults with traumatic SCI and 1,474,232 adults without SCI

Evidence Level

Longitudinal cohort study

Key Findings

1
Adults with SCI had a higher incidence of psychological morbidities compared to those without SCI.
2
Chronic centralized and neuropathic pain was associated with a higher risk of all psychological disorders studied.
3
The presence of chronic pain was often more strongly linked to psychological issues than the SCI itself.

Research Summary

Adults with traumatic SCI are at increased risk for developing both general psychological morbidity as well as most specific psychological conditions. Chronic centralized and neuropathic pain is robustly associated with all psychological morbidity. Improving clinical screening strategies and developing efficient referral resources for coordinated care may help reduce the burden of mental health disorders in this high need population.

Practical Implications

Early Pain Management

Improved referral networks for early pain phenotyping and management after SCI are needed.

Targeted Pain Treatment

Understanding the mechanisms of pain in SCI is vital for prescribing appropriate and effective pain management interventions.

Integrated Mental Health Screening

Physicians should integrate monitoring of and screening for psychological sequelae among patients with SCI as a standard part of clinical practice.

Study Limitations

1
Inability to determine several basic clinical characteristics of the SCI cohort (e.g., the severity of disability, exact time after injury, type of paralysis) through claims-based data.
2
The sample may be more reflective of a healthier, higher functioning segment of the traumatic SCI, because they had to be enrolled in private insurance.
3
Administrative claims data may be prone to inaccurate coding of medical diagnoses, such as SCI, as well as chronic diseases, which may affect incidence estimates.

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