Chronic pain in spinal cord injury: comparison between inpatients and outpatients

Chronic pain is a common clinical finding in spinal cord injury (SCI), with a reported incidence of between 45% and 90%. This figure was obtained by using nonstandardized pain evaluation and for mostly inpatient populations. Because of the shortcomings of previous investigations and the wide range of reported incidence, a study was conducted using self-rating pain measurement, an activity check list, and a drug-use rating scale. Pain in 40 hospitalized SCI patients (19 quadriplegics and 21 paraplegics) was evaluated according to the self-rating pain scale and for physical activities. The medical record of each of these patients was then reviewed to evaluate use of pain medications. Using the same method, 24 outpatients (12 with quadriplegia and 12 with paraplegia) in the Hospital Based Home Care Program were studied. Statistical analysis showed an incidence of chronic pain and decreased activity of 60% among inpatients and of 16.6% in outpatients. The drug-use rating scale was also significantly higher among inpatients while outpatients had a higher level of physical activity than inpatients. Whether these differences are causally related to the patient's hospitalization is difficult to determine.