Pain Intensity, Interference, and Medication Use after Spinal Cord Injury: Relationship with Risk of Mortality after Controlling for Socioeconomic and Other Health Factors

Publication date: Available online 23 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): James S. Krause, Yue Cao, Jillian M.R. Clark
ObjectiveTo identify the relationships of pain intensity, pain interference, and pain medication use with risk of mortality after spinal cord injury (SCI), controlling for demographic, injury, socioeconomic, and health factors.DesignProspective data collection occurred in 2007-2009 as part of a larger longitudinal study initiated in 1997-1998. Mortality status was determined as of December 31, 2014 using the National Death Index. A 3-stage Cox proportional hazards model was generated, with different sets of predictors entered at each step.SettingAcademic medical center in Southeastern United States.ParticipantsAll participants had traumatic SCI of at least 1-year duration at enrollment, with non-complete recovery (AIS A-D). Mortality status was obtained for 2,535 individuals, and 335 were deceased as of 2014.Interventionsn/aMain Outcome Measure(s)Mortality status.ResultsPreliminary bivariate analyses indicated deceased participants were more likely to be older at injury, have more years post injury, be male, and have a severe injury, low income, less education, and poorer health indicators. The final Cox model indicated those who used pain medication daily were 51% more likely to be deceased at follow-up (HR=1.51). Pain intensity and pain interference were not statistically significant. Non-chronic pressure sore was related to 67% higher mortality risk (HR=1.67), and chronic pressure sore 122% higher risk (HR=2.22). Other health indicators also increased the risk of mortality from 43%-73%, including hospitalization (HR=1.54), depression (HR=1.43), and amputation (HR=1.73).ConclusionsPrescription pain medication use appears to have a direct relationship with mortality, beyond that associated with other characteristics, and should become a strong focus of prevention efforts.



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