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Relationships between cardiovascular disease risk, neuropathic pain, mental health, and autonomic function in chronic spinal cord injury


Study design

Multicentre, cross-sectional study.


To determine if clinical measures of poor mental health (MH-) and neuropathic pain (NP) are related to increased CVD risk in individuals with chronic spinal cord injury (SCI), and further elucidate the relationships between CVD risk, autonomic function, NP, and MH-.


Eight SCI rehabilitation centres in the Netherlands.


Individuals (n = 257) with a traumatic, chronic (≥10 yrs) SCI, with age at injury between 18–35 years, completed a self-report questionnaire and a one-day visit to a rehabilitation centre for testing. CVD risk was calculated using Framingham risk score. NP was inferred using The Douleur Neuropathique 4 clinical examination, and MH- was assessed using the five-item Mental Health Inventory questionnaire. Cardiovascular autonomic function was determined from peak heart rate during maximal exercise (HRpeak).


There was a high prevalence of both NP (39%) and MH- (45%) following SCI. MH- was significantly correlated with an adverse CVD risk profile (r = 0.174; p = 0.01), increased the odds of adverse 30-year CVD risk by 2.2 (CI 0.92–2.81, p = 0.02), and is an important variable in determining CVD risk (importance=0.74, p = 0.05). Females (p = 0.05) and those with a higher HRpeak (p = 0.046) tended to be more likely to have NP.


Clinical measures of MH-, but not NP, are important factors for increased CVD risk following SCI. NP tended to be more prevalent in those with more preserved cardiovascular autonomic function. The interrelationships between secondary consequences of SCI are complex and need further exploration.

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Fig. 1: Akaike Information Criterion model-averaged importance of predictors of CVD risk.

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.


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We are grateful to Dr. Vera-Ellen Lucci for her contribution to this work.



This study is part of the Dutch ALLRISC research program and is supported financially by ZonMw Rehabilitation program and Fonds NutsOhra, grant no. 89000006.

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Authors and Affiliations



JKK, MCD, and VEC conceived the idea for the study. MWMP and SDG designed the study protocol and collected the data. MCD and VEC analysed the data. JKK, MWMP, and SDG assisted in interpreting the results. MCD and VEC wrote the manuscript. VEC supervised the research. All authors contributed to the critical revision of the manuscript.

Corresponding author

Correspondence to Victoria E. Claydon.

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Dorton, M.C., Kramer, J.K., de Groot, S. et al. Relationships between cardiovascular disease risk, neuropathic pain, mental health, and autonomic function in chronic spinal cord injury. Spinal Cord 61, 548–555 (2023).

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