Yenisel Cruz-Almeida

Chronicity of pain associated with spinal cord injury: A longitudinal analysis

This study determined the stability of self-reported clinical pain characteristics and pain-induced interference with sleep and daily activities in people with spinal cord injury. The study followed up a previous survey that identified clinical pain patterns (i.e., neuropathic pain below the level of injury; upper-limb pain in tetraplegia; and severe, persistent pain). A confirmatory factor analysis (CFA) of the present studys data confirmed the previously observed pain patterns. The CFA also confirmed positive correlations between the surveys on individual pain characteristics (i.e., number of pain locations [r = 0.63, p < 0.001], number of descriptors [r = 0.61, p < 0.001], pain intensity [r = 0.68, p < 0.001], and temporal aspects [r = 0.47, p < 0.001]). Despite an overall stable clinical picture of pain, aching pain (p < 0.001) and sleep interference caused by pain (p < 0.001) significantly increased over time.

Chronic pain after spinal cord injury: What characteristics make some pains more disturbing than others?

Different types of pain are often present in the same individual with spinal cord injury (SCI). Relieving the most disturbing of these pains may substantially affect quality of life. Persons with SCI and chronic pain (n = 194) completed a structured interview that detailed the characteristics of each pain they experienced. Pairwise analyses revealed that the following characteristics were more common among the most disturbing pains: sharp; stabbing; located at the level of injury; frequently aggravated; and having high intensity, unpleasantness, constancy, interference, and neuropathic pain-like features. A conditional logistic regression analysis showed that the combination of sharp and high pain intensity, interference, aggravation, and constancy significantly predicted the most disturbing pain (p < 0.001). This study suggests that, in addition to pain intensity, factors such as interference, quality, aggravation, and constancy of pain are important to consider when one evaluates SCI-related pain, since these symptoms may indicate pains that are particularly disturbing to an individual with SCI.

Is There a Relationship between Chronic Pain and Autonomic Dysreflexia in Persons with Cervical Spinal Cord Injury

The purpose of this study was to define the relationships among clinical characteristics of chronic pain, injury characteristics, affective factors and autonomic dysreflexia (AD) in people with chronic cervical spinal cord injury (SCI). A survey containing questions concerning the presence of AD, demographic factors, clinical characteristics of pain and affective symptoms, was mailed to people with traumatic SCI and chronic pain included in the Miami Project to Cure Paralysis database. Of all subjects (n = 330) reporting chronic pain in a previous study, 181 had cervical injuries. Of this subset, 117 (64.6%) participated in the study. Thirty-five people (29.9%) reported AD in our study. Although intense pain has previously been reported to trigger AD, the average pain intensity was not predictive of AD. Pair-wise comparisons indicated that people reporting AD marked significantly more painful areas in the drawing and used more descriptive pain adjectives. Anxiety and sadness were significantly more frequent among people with AD. Furthermore, aggravation of pain due to muscle spasms, infections, full bladder, and constipation was significantly more common among people with AD. The logistic regression analysis indicated that a combination of having widespread pain, experiencing aggravation of pain due to infections, having a complete injury, and experiencing anxiety significantly predicted AD. Our results suggest that relationships between chronic pain and AD exist. Since multiple pain types are common after SCI and may be associated with AD, it is important to determine which pain types that may be particularly important for the condition of AD.

Pain Symptom Profiles in Persons with Spinal Cord Injury

OBJECTIVEnPersistent pain is a common consequence of spinal cord injury. A patient-specific assessment that combines both the identification of pain symptoms and psychosocial factors is needed for a tailored treatment approach. The aim of the study was to define pain symptom profiles and to determine their relationship with psychosocial factors in persons with spinal cord injury.nnnDESIGNnFace-to-face interview and examination.nnnSETTINGnVA Medical Center and Miami Project to Cure Paralysis, Miami, Florida.nnnPATIENTSnPersons with spinal cord injury (135 men and 21 women) provided detailed descriptions of 330 neuropathic pains.nnnOUTCOME MEASURESnThe American Spinal Injury Impairment Scale, pain history and measures of pain interference, life satisfaction, locus of control, social support and depression.nnnRESULTSnThe exploratory factor analyses and regression analyses revealed three distinct symptom profiles: 1) aching, throbbing pain, aggravated by cold weather and constipation predicted by a combination of chance locus of control and lower levels of life satisfaction; 2) stabbing, penetrating, and constant pain of high intensity predicted by a combination of pain interference, localized pain, powerful others locus of control and depressed mood; and 3) burning, electric, and stinging pain aggravated by touch and muscle spasms predicted by pain interference.nnnCONCLUSIONSnAlthough these results need to be replicated in other spinal cord injury samples, our findings suggest that pain symptom profiles may be a useful way to further characterize pain in a comprehensive assessment strategy.

Relationship between pain characteristics and pain adaptation type in persons with SCI.

After a spinal cord injury (SCI), people commonly experience several types of persistent pain. Unfortunately, individuals who experience unremitting pain despite various treatments have no choice but to adapt to their pain. Although people may possess different styles of pain adaptation, one can hypothesize that the specific types of pain a person experiences are also important. The present study determined the association between pain characteristics and specific adaptational patterns to pain after SCI. Participants (N = 182) were interviewed regarding pain characteristics and the impact of pain on their psychosocial status. Based on the SCI version of the Multidimensional Pain Inventory (MPI-SCI), they were classified as Dysfunctional, with higher pain severity (PS) and life interference (LI); Interpersonally Supported, with moderately high PS, high social support levels, and less LI; or Adaptive Coper, with lower PS and LI levels. A multinomial logistic regression analysis indicated a robust model fit (chi-square = 63.6, p < 0.0005), predicting MPI-SCI subgroup membership based on a combination of pain intensity (p < 0.0005), extent of pain aggravation (p < 0.01), electric quality of pain (p < 0.01), constancy of pain (p < 0.01), and distribution of pain (p < 0.05). The results of the present study support the biopsychosocial model of pain.

Somatosensory phenotype is associated with thalamic metabolites and pain intensity after spinal cord injury.

Abstract Neuropathic pain is one of the most difficult consequences of spinal cord injury (SCI). The clinical correlates of the underlying mechanisms responsible for neuropathic pain are not well understood, although methods such as quantitative somatosensory testing (QST) or brain imaging have been used to further a mechanism-based understanding of pain. Our previous SCI study demonstrated a significantly lower glutamate-glutamine/myo-inositol ratio (Glx/Ins) in the anterior cingulate cortex in persons with severe neuropathic pain compared with those with less severe neuropathic pain or pain-free, able-bodied controls, suggesting that a combination of decreased glutamatergic metabolism and glial activation may contribute to the development of severe neuropathic pain after SCI. The present study aimed to determine the relationships between somatosensory function below the level of injury and low thalamic Glx/Ins in persons with intense neuropathic pain after SCI. Participants underwent QST and a 3 Tesla proton magnetic resonance spectroscopy. A cluster analysis including SCI participants resulted in 1 group (n = 19) with significantly (P < 0.001) greater pain intensity (6.43 ± 1.63; high neuropathic pain [HNP], and lower Glx/Ins [1.22 ± 0.16]) and another group (n = 35) with lower pain intensity ratings (1.59 ± 1.52, low neuropathic pain [LNP], and higher Glx/Ins [1.47 ± 0.26]). After correcting for age, QST indicated significantly greater somatosensory function in the HNP group compared with the LNP group. Our results are consistent with research suggesting that damage to, but not abolition of, the spinothalamic tract contributes to development of neuropathic pain after SCI and that secondary inflammatory processes may amplify residual spinothalamic tract signals by facilitation, disinhibition, or sensitization.