Pain, depression, and health care utilization over time after spinal cord injury.
Abstract
OBJECTIVE: The aim of this research was to examine comorbid pain and depression after spinal cord injury (SCI) in terms of: frequency, longitudinal course, and associations with medical conditions and use of SCI specialty care. METHOD: Three consecutive standardized annual psychological evaluations were reviewed for 286 persons with SCI receiving care at an SCI specialty care center. Chart abstraction included medical and demographic information, a depression scale, and a pain scale. Administrative databases were used to collect SCI specialty care utilization data. Participants were categorized as having elevated pain, elevated depression, both elevated pain and depression, or neither elevated, using cut-off scores on the pain and depression scales. ANOVA and repeated measures ANOVA were used to compare study groups. RESULTS: Approximately 20% of the sample showed both elevated pain and depression at Year 1. Persons with elevated pain and depression showed higher scores on those measures than did persons with either pain or depression alone. Pain scores tended to be stable over time. Depression scores tended to improve over 3 years, but persons with elevated pain and depression showed less improvement on depression scores than did persons with depression alone. Persons with pain and depression tended to utilize more SCI specialty care. CONCLUSIONS: Pain and depression are often comorbid after SCI. This comorbidity is associated with higher pain and depression severity, more persistent pain and depression over time, and more use of SCI specialty care. Comorbid pain and depression should be anticipated among persons with SCI and addressed in care plans.
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Trials of cognitive behavioural therapy for depression in people with spinal cord injury have shown conflicting results, with some demonstrating a positive impact and others no change.
“Some trials examining cognitive behavioural therapy (CBT) have demonstrated a positive impact on depression [4], whilst others have demonstrated no change [6].”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [4]
A complex relationship exists between depression and chronic pain in people with spinal cord injury, with each amplifying the other.
“Further, evidence suggests that a complex relationship between depression and chronic pain exists, with each amplifying the other in this population [4].”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [4]
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- Authors
- Ullrich, P. M., Lincoln, R. K., Tackett, M. J., Miskevics, S., Smith, B. M., & Weaver, F. M.
- Affiliations
- United States Department of Veterans Affairs (US)
- VA Puget Sound Health Care System (US)
- Venue
- Rehabilitation Psychology
- Published
- 2013
- Volume
- 58
- Issue
- 2
- Pages
- 158-165
- ISSN
- 0090-5550 (ISSN-L)
- 1939-1544
- OpenAlex
- W1992558825
- Cited by
- 60
- References
- 53
- Citations by year
- 2025: 3 · 2024: 5 · 2023: 6 · 2022: 5 · 2021: 2 · 2020: 6 · 2019: 2 · 2018: 5 · 2017: 6 · 2016: 6 · 2015: 5 · 2014: 7 · 2013: 2
- FWCI
- 4.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Rehabilitation Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Department of Veterans, Veterans Health Administration, Health Services Research and Development Service, Spinal Cord Injury Quality Enhancement Initiative
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- spinal cord injury, chronic pain, depression, comorbidities, health care utilization, longitudinal course, psychological outcomes
- MeSH terms
- Analysis of Variance, Depressive Disorder, Female, Health Services, Humans, Male, Middle Aged, Pain, Pain Measurement, Psychiatric Status Rating Scales, Spinal Cord Injuries, United States, Veterans, Comorbidity
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