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Psychological morbidity following spinal cord injury and among those without spinal cord injury: the impact of chronic centralized and neuropathic pain

Abstract

Study design

Longitudinal cohort study of privately insured beneficiaries with and without traumatic spinal cord injury (SCI).

Objectives

Compare the incidence of and adjusted hazards for psychological morbidities among adults with and without traumatic SCI, and examine the effect of chronic centralized and neuropathic pain on outcomes.

Setting

Privately insured beneficiaries were included if they had an ICD-9-CM diagnostic code for traumatic SCI (n = 9081). Adults without SCI were also included (n = 1,474,232).

Methods

Incidence of common psychological morbidities were compared at 5-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities.

Results

Adults with SCI had a higher incidence of any psychological morbidity (59.1% vs. 30.9%) as compared to adults without SCI, and differences were to a clinically meaningful extent. Survival models demonstrated that adults with SCI had a greater hazard for any psychological morbidity (HR: 1.67; 95%CI: 1.61, 1.74), and all but one psychological disorder (impulse control disorders), and ranged from HR: 1.31 (1.24, 1.39) for insomnia to HR: 2.10 (1.77, 2.49) for post-traumatic stress disorder. Centralized and neuropathic pain was associated with all psychological disorders, and ranged from HR: 1.31 (1.23, 1.39) for dementia to HR: 3.83 (3.10, 3.68) for anxiety.

Conclusions

Adults with SCI have a higher incidence of and risk for common psychological morbidities, as compared to adults without SCI. Efforts are needed to facilitate the development of early interventions to reduce risk of chronic centralized and neuropathic pain and psychological morbidity onset/progression in this higher risk population.

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Fig. 1: Flow chart of subject inclusion and exclusion for final case and control cohorts.
Fig. 2

Data availability

All data accessed for this study were purchased through the ClinformaticsTM Data Mart Database, a de-identified nationwide claims database of all beneficiaries from a single private payer. Thus, data are not eligible or available for public data access.

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Acknowledgements

This research was developed in part under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR #90RTHF0001-01-00).

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Authors

Contributions

MP and EM were responsible for designing the conceptual framework of the study. PL and NK conducted the statistical analyses. MM, GR, and JK contributed substantially to the data interpretation and the article preparation. All authors provided writing support and contributed to the editing of the final manuscript.

Corresponding author

Correspondence to Mark D. Peterson.

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Ethics statement

This study was deemed exempt by the Institutional Review Board at the researchers’ institution.

Competing interests

The authors declare no competing interests.

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Peterson, M.D., Meade, M.A., Lin, P. et al. Psychological morbidity following spinal cord injury and among those without spinal cord injury: the impact of chronic centralized and neuropathic pain. Spinal Cord 60, 163–169 (2022). https://doi.org/10.1038/s41393-021-00731-4

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  • DOI: https://doi.org/10.1038/s41393-021-00731-4

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