Differences in functional improvement based on history of substance abuse and pain severity following spinal cord injury

Abstract

Background: This study explored the relationship between history of substance abuse and pain severity during inpatient rehabilitation following traumatic spinal cord injury (SCI). Methods: Secondary analysis of a prospective longitudinal study. An adjusted general linear model was used to examine differences in functional improvement based on history of substance abuse and pain severity. Results: Over 50% of the sample had a history of substance abuse, and 94% reported moderate or severe pain. There was a significant interaction between the history of substance abuse and pain severity (p = 0.01, partial η² = 0.012). A difference in functional improvement was found among individuals who reported low pain; those with a history of substance abuse achieved less functional improvement than those without a history of substance abuse, M = 5.32, SE = 1.95, 95% CI 0.64–10.01. Conclusions: A history of substance abuse and post-injury pain are prevalent among individuals with SCI in rehabilitation, and there may be a meaningful relationship between these two patient characteristics and functional improvement. The results provide potential new insights into the characteristics of vulnerable subpopulations during SCI rehabilitation. Furthering our understanding of these results warrants future investigation to prevent and minimize poor outcomes among vulnerable SCI patients.

Keywords:

• Spinal cord injuries
• substance-related disorders
• pain
• vulnerable populations

Authors’ contributions

Alexandra Harper contributed to study conception and design, analysis and interpretation of data, and drafting and finalizing the article. James Krause contributed to the interpretation of data, article revision, and final approval. Lauren Terhorst contributed to data analysis and interpretation, article revision, and final approval. Natalie Leland contributed to the interpretation of data, article revision, and final approval.

Acknowledgments

The authors would like to acknowledge the thoughtful insights of Howard Degenholtz, PhD, Sih-Ting Cai, MPA, Yitong (Alice) Gao, MPH, and Amy C. Raslevich, MPP, MBA during idea conception and Elizabeth Skidmore, PhD, OTR/L, FAOTA, FACRM during article revision.

Data availability statement

Data from the SCIRehab Study (PI: Whiteneck) are available from the Inter-university Consortium for Political and Social Research (ICPSR) at: https://doi.org/10.3886/ICPSR36724.v1. The ICPSR had no role in the current study.

Additional information

Funding

The parent study was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, United States Department of Health and Human Services [H133A060103 and H133N060005].