PAIN AND DEPRESSION IN ACUTE TRAUMATIC SPINAL-CORD INJURY - ORIGINS OF CHRONIC PROBLEMATIC PAIN

Objective: To examine the relationship between pain and depression ove r time during acute phases of traumatic spinal cord injury (SCI). Theo retical models of the pain-depression relationship provided a framewor k: (1) pain causes depression; (2) depression causes pain; (3) pain an d depression are independent sequelae to SCI. Understanding the pain-d epression 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. Se tting: Subjects were admitted to a large public hospital in Southern C alifornia which is a member of the Model Spinal Cord Injury Care Syste m. Rehabilitation occurred on two 30 bed units. Participants: Complete admission and discharge data sets were collected from 68 acute trauma tic SCI patients who served as subjects. One hundred twenty-one patien ts 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 pa id a fee. Intervention: A standard rehabilitation program for SCI. Mea sures: Pain assessment used a 101-point numerical rating scale. Depres sion assessment used the Center for Epidemiological Studies-Depression Scale (CESD). Results: Pain and depression were independent at admiss ion. At discharge, they were significantly related. Changes in pain af fected depression more than changes in depression affected pain. Concl usions: Relationships between pain and depression develop over time. R educed pain will have a greater effect on reducing depression than red uced depression will have on pain. Pain described as ''burning'' durin g the acute phase does not represent difficult to treat dysesthetic pa in, as it may in chronic SCI pain. (C) 1996 by the American Congress o f Rehabilitation Medicine and the American Academy of Physical Medicin e and Rehabilitation