Spinal Cord Injury-related Chronic Pain In Victims Of The2008Sichuan Earthquake

Objectives:To characterize spinal cord injury (SCI)-related pain and treatment in victims of the2008Sichuan earthquake.Methods:Twenty-six patients who sustained SCI in the2008Sichuan earthquake and who were treated in the Mianzhu hospital were enrolled. From2009May to2012Oct, patients received four assessments. Data was collected on pain severity with a visual analog scale, depression with Patient Health Questionnaire-9(PHQ-9), physical functioning with Modified Barthel Index(MBI), quality of life with World Health Organization Quality of Life-BREF(WHOQOL-Bref) and social participation with the Craig Hospital Handicap Assessment and Reporting Technique Short Form(CHART) at the first three assessments(2009May,2010Aug, and2012July). Detailed pain information were queried at the fourth assessment(2012Oct), including pain severity, timing, location, pattern, quality(descriptors), aggravating andalleviating factors, and therapeutic interventions. Pain determinants were analyzed with a longitudinal Tobit regression, and Pearson’s correlations ofpain severity with depression, QoL and social participation stratified by measurement point were calculated.Results’. SCI-related pain was highly prevalent, and mean pain score was not significantly reduced over time. In2012Oct, the pain prevalence in this population was96%, mean VAS score was4.52±2.52. Onset of pain ranged since the time of injury to12months.Pain duration ranged from41to53months, averaging48months (s.d.:3.8).Most Pain were described as continuous or intermittent, occurred in the lower extremities, and were described as "numb"(59%) or "burning"(50%). Aggravating factors included cold weather and body posture, whereas distracting activities, resting and medication were alleviating factors. Most of patients were classified as neuropathic pain. Seven patients tried pharmacological treatments, and three of them reported no improvement in pain symptoms.Most patients who did not seek pain treatment from a doctor either believed that pain following SCI was normal, and therefore should be tolerated, without physician’s intervention(n=10), feared addiction to pain medication(n=5) or thought that pain medication would be ineffective(n=2).Cervical injury, complete lesions andeducation level were significant pain determinants.Depression and QoL scores were highly correlated with pain at the first twoassessments points but not at the third measurement.Conclusion: Chronic pain is common among this population, and average pain severity didn’t significantly decrease over time. Significant pain determinants are cervical injury, complete lesions andeducation level, while depression and QoL scores arecorrelation factors. Patient pain-treatment-seeking behavior and therapeutic interventions should be evaluatedconcurrently.