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Neuropathic Pain Severity Is Associated With Opioid Use in Adults With Traumatic Spinal Cord Injury: A Spinal Cord
Leslie R Morse1, Thomas N Bryce2, Argyrios Stampas3,4
1Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, UHealth/Jackson Rehabilitation Care, Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.
Topics in Spinal Cord Injury Rehabilitation
|April 24, 2026
Summary
Biopsychosocial factors influence opioid use in adults with spinal cord injury (SCI) and neuropathic pain. Employment and paraplegia impact opioid use, with pain severity increasing odds.
Area of Science:
- Neurology
- Pain Management
- Rehabilitation Medicine
Background:
- Neuropathic pain is a common complication following spinal cord injury (SCI).
- Opioid medications are frequently prescribed for chronic pain, but their use in SCI populations requires careful consideration of associated factors.
- Understanding the biopsychosocial determinants of opioid use is crucial for effective pain management strategies in adults with SCI.
Purpose of the Study:
- To identify biopsychosocial factors associated with opioid use for neuropathic pain in adults with SCI.
- To develop a predictive model for opioid use in this population.
Main Methods:
- A cross-sectional study involving 283 adults with SCI from 6 SCI Model System centers.
- Data collected using International Spinal Cord Injury Pain Basic and Extended Data Sets, including pain characteristics, medication use, and nonpharmacological treatments.
- Logistic regression analysis was employed to examine the relationship between opioid use and various factors, adjusting for clinical and demographic variables.
Main Results:
- Opioid users (n=104) differed significantly from nonusers (n=179).
- Employment was associated with a 33% reduction in opioid use.
- Individuals with paraplegia were nearly twice as likely to use opioids compared to those with tetraplegia.
- Higher neuropathic pain severity (1-point increase) correlated with a 10% increase in the odds of opioid use.
- Opioid users were more likely to use anti-epileptics, cannabis combinations, or NSAIDs.
Conclusions:
- A biopsychosocial model for opioid use in adults with chronic pain after SCI was developed.
- The model demonstrated good cross-sectional predictive performance (AUC=0.74).
- Key risk factors for opioid use, including pain severity, employment status, and level of injury, were identified.
