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Pain, anxiety and depression in spinal cord injured patients
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
Department of Neurobiology, Care Sciences and Society, Division of Neurodegeneration, Section Neurorehabilitation, Karolinska Institutet, Sweden; Rehab Station, Stockholm/Spinalis R&D Unit, Sweden.
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2017 (English)In: Jacobs Journal of Physical Rehabilitation Medicine, ISSN 2469-3103, Vol. 3, no 1, 028Article in journal (Refereed) In press
Abstract [en]

Objective: To assess the prevalence of pain, anxiety and depression in a sample of chronic SCI patients in Northern Sweden. Design: Descriptive, cross-sectional study. Setting: Specialist Clinic at a University Hospital. Participants: 78 patients with chronic spinal cord injury, at different injury and functional level. Outcome measures: Patients registered presented pain above, at or below injury level on a Visual Analogue Scale (VAS). Patients currently on pain medication were also registered as having pain. Depression and anxiety were assessed by the Hospital Anxiety and Depression Rating Scale (HADS). Results: Out of 78 patients, 58 (74%) indicated current presence of pain or were on continuous pain medication. Pain above injury level was present in 32% of the patients, with a mean VAS of 15.9±20.1, range 0-60mm. Pain at injury level were present in 24% of the patients, mean VAS 11.0±17.0, range 0-50mm and 58% had pain below injury level with a mean VAS 31.4±22.3, range 0-80mm. Clinically significant psychological disorders were reported in 4 patients (5%) for both anxiety and depression. Conclusions: Pain is very common in persons with chronic SCI, but, at least in a drug-treated population, the pain is at a mild or moderate level. Anxiety and depression were found much less common than reported in other studies. Medication effects have been considered. Even in a presumably well-medicated and well-rehabilitated population, there is still a need for further optimization of pain management, including both pharmacological and non-pharmacological methods.

Place, publisher, year, edition, pages
2017. Vol. 3, no 1, 028
Keyword [en]
Tetraplegia, Paraplegia, Psychological Disorders, Visual Analogue Scale, Hospital Anxiety and Depression Scale
National Category
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-125201OAI: oai:DiVA.org:umu-125201DiVA: diva2:963129
Note

First published in thesis in submitted form.

Available from: 2016-09-08 Created: 2016-09-08 Last updated: 2017-10-11
In thesis
1. Spinal cord injuries in Sweden: studies on clinical follow-ups
Open this publication in new window or tab >>Spinal cord injuries in Sweden: studies on clinical follow-ups
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A spinal cord injury is a serious medical condition, often caused by a physical trauma. An injury to the spinal cord affects the neurotransmission between the brain and spinal cord segments below the level of injury. The SCI causes a loss of motor function, sensory function and autonomic regulation of the body, temporary or permanent. Significantly improved acute care, primary comprehensive rehabilitation and life-long structured follow-up has led to persons with spinal cord injury (SCI) living longer than ever before. However, increased long-time survival has allowed secondary conditions to emerge, like diabetes mellitus and where cardiovascular disease (CVD) now is the most common cause of death among SCI patients. Other possible CVD-related comorbidities in this patient group have been reported to be pain and mood disturbances. There is still lack of, and need for more knowledge in the field of CVD-related screening and prevention after SCI.

The overall aim of this thesis was to contribute to a scientific ground regarding the need for CVD-related screening and prevention after SCI.

In Paper I and Paper II, patients with wheelchair-dependent post-traumatic SCI (paraplegia) were assessed. The results in paper I showed that 80% of the examined patients had at least one cardiovascular disease risk marker irrespective of body mass index (BMI). Dyslipidemia was common for both men and women at all BMI categories. The study also showed a high prevalence of hypertension, especially in men. Paper II showed a low frequency of self-reported physical activity, where only one out of 5 persons reported undertaking physical activity >30 min/day. The physically active had lower diastolic blood pressure but no significant difference in blood lipids.

In paper III and IV, patients with SCI (tetraplegia and paraplegia) participated in the studies. Eighty-one percent of the patients had dyslipidemia, where also a majority of the patients with normal abdominal clinical measures had dyslipidemia. Self-reported physical activity >30min/day was reported by one third of the patients. No differences were found between physically active and not physically active patients when it came to blood glucose, serum lipid values and clinical measures (paper III). Pain was common in the patient group, however, most often on a mild to moderate level. Anxiety and depression was less common than reported in other studies (paper IV).

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. 73 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1824
Keyword
Tetraplegia, paraplegia, cardiovascular disease, prevention, anthropometry, physical activity
National Category
Neurology
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-125202 (URN)978-91-7601-526-1 (ISBN)
Public defence
2016-09-30, Aulan, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-09-09 Created: 2016-09-08 Last updated: 2016-09-23Bibliographically approved

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