Upper limb pain in a national sample of veterans with paraplegia

The purpose of this survey study was to examine the prevalence and intensity of pain and associated patient characteristics in a national sample of veterans with paraplegia. Of particular interest were upper limb (UL) pain conditions, which pose unique challenges to individuals who use a wheelchair for mobility. Because the risk for UL pain conditions appears to increase over time, the associations among age, duration of wheelchair use, and UL pain were evaluated.

A group of 1,675 individuals between the ages of 18 and 65 with a lesion between T2 and L2 and a mailing address on file were selected randomly from the Veteran's Affairs Spinal Cord Dysfunction Registry and mailed a survey packet. Of the deliverable packets, approximately 46% were completed and returned.

Approximately 81% of the respondents reported at least a minimal level of ongoing unspecified pain and 69% experienced current UL pain. Shoulder pain intensity was most severe during the performance of wheelchair-related mobility and transportation activities, suggesting that UL pain may have a significant impact on functional independence. Duration of wheelchair use modestly predicted shoulder pain prevalence and intensity, but age and the interaction between age and duration of wheelchair use did not.

The data of the present study suggest that the development, persistence, and exacerbation of UL pain conditions in persons with paraplegia are multidimensional processes. A comprehensive theoretic model is needed to integrate the existing empiric literature in this area.