Pain and depression in acute traumatic spinal cord injury: Origins of chronic problematic pain?

Abstract

Objective: To examine the relationship between pain and depression over time during acute phases of traumatic spinal cord injury (SCI). Theoretical models of the pain-depression relationship provided a framework: (1) pain causes depression; (2) depression causes pain; (3) pain and depression are independent sequelae to SCI. Understanding the pain-depression relationship provides treatment implications and hypotheses for origins of chronic pain in SCI. Design: A repeated measures design assessing subjects at admission and discharge from rehabilitation. Setting: Subjects were admitted to a large public hospital in Southern California which is a member of the Model Spinal Cord Injury Care System. Rehabilitation occurred on two 30-bed units. Participants: Complete admission and discharge data sets were collected from 68 acute traumatic SCI patients who served as subjects. One hundred twenty- one patients initially agreed to participate in a larger study of adjustment to SCI. Thirty-three did not have pain data at admission, 16 dropped out, and 4 had incomplete discharge data. Subjects volunteered and were paid a fee. Intervention: A standard rehabilitation program for SCI. Measures: Pain assessment used a 101-point numerical rating scale. Depression assessment used the Center for Epidemiological Studies-Depression Scale (CESD). Results: Pain and depression were independent at admission. At discharge, they were significantly related. Changes in pain affected depression more than changes in depression affected pain. Conclusions: Relationships between pain and depression develop over time. Reduced pain will have a greater effect on reducing depression than reduced depression will have on pain. Pain described as 'burning' during the acute phase does not represent difficult to treat dysesthetic pain, as it may in chronic SCI pain.