Effects of Depression and Resilience During Acute Inpatient Rehabilitation on Pain Outcomes One Year After Spinal...

Chronic pain is a common and debilitating consequence of spinal cord injury (SCI) that interferes with many aspects of life. Although resilience can be a protective factor, few studies have examined its role in pain outcomes post SCI.

To examine whether depression and resilience, measured during inpatient rehabilitation, were predictive of pain severity and interference 1 year post SCI, whether resilience moderated the impact of depression on pain outcomes, and whether these relationships differed by pain type (neuropathic or non-neuropathic).

Data were drawn from 2327 individuals enrolled in the National SCI Model Systems Database. Depression and resilience were measured during inpatient rehabilitation and pain outcomes were obtained at 1 year post injury. Regression models tested main and interactive effects of resilience and depression on overall pain outcomes, and mixed models examined these effects across pain types.

Early depression consistently predicted future pain outcomes post SCI, demonstrating stronger associations with overall pain intensity and interference than resilience, which showed minimal independent effects. Early resilience was not associated with later pain interference. Although a modest depression by resilience interaction emerged in some models, depression largely overshadowed any protective influence of resilience. Moderating effects did not differ by pain type, though neuropathic pain was associated with higher pain intensity and greater interference with sleep.

Level of depressive symptoms during acute rehabilitation is a robust predictor of pain outcomes 1 year post SCI, whereas resilience demonstrates limited predictive value and does not substantially moderate depression's association with pain.