Pain and its impact on inpatient rehabilitation for acute traumatic spinal cord injury: analysis of observational data collected in the SCIRehab study.
OBJECTIVE
To describe pain during inpatient rehabilitation and its impact on delivery of inpatient rehabilitation services for persons with spinal cord injury (SCI).


DESIGN
Prospective observational study and retrospective chart review.


SETTING
Six inpatient rehabilitation facilities participating in the SCIRehab Study.


PARTICIPANTS
Patients (N=1357) receiving initial rehabilitation after traumatic SCI, for whom pain data were available.


INTERVENTIONS
Not applicable.


MAIN OUTCOME MEASURES
Self-reported rating of pain intensity (0-10), pain locations, and treatment time by various rehabilitation disciplines.


RESULTS
The vast majority of patients (97%) reported pain at least once during the rehabilitation stay, with an average pain intensity ± SD of 4.9 ± 2.4. Average pain intensity over the stay was severe (rated 7-10) for 30% of patients, moderate (4-6) for 42%, and mild (1-3) for 25%. Pain prevalence at admission was greater than at discharge (87% vs 74%), as was pain intensity (6.0 vs 4.6). Most (79%) of the 177 participants who did not have pain at admission reported pain at least once later in the rehabilitation stay, but their average high pain intensity over the stay was lower than that of the full sample (1.9 vs 4.9). Nearly half (47%) of patients reported pain at ≥ 3 locations during the stay, with the back, neck, and shoulder commonly reported. Patients with severe pain spent fewer days in rehabilitation, received less rehabilitation treatment time (hours per week and total hours), and had more treatment sessions altered in objective or content because of pain than those with lower pain levels.


CONCLUSIONS
Pain is a common problem for persons receiving inpatient rehabilitation for traumatic SCI and adversely impacts delivery of therapy services.