Article

OBJECTIVE: To identify the association of pain intensity, pain interference, and
pain medication use with risk of mortality after spinal cord injury, controlling
for demographic, injury, socioeconomic, and health factors. DESIGN: Prospective
cohort study. SETTING: Academic medical center. PARTICIPANTS: All participants
(N=2535) had traumatic spinal cord injury of at least 1-year duration at
enrollment, with noncomplete recovery (American Spinal Injury Association
Impairment Scale grades A-D). Mortality status was obtained for 2535 individuals,
and 335 were deceased as of 2014. INTERVENTIONS: Not applicable. MAIN OUTCOME
MEASURES: Mortality status as of December 31, 2014, identified by the National
Death Index. RESULTS: Preliminary bivariate analyses indicated that deceased
participants were more likely to be older at injury, have more years postinjury,
be men, and have a severe injury, low income, less education, and poorer health
indicators. The final Cox model indicated that those who used pain medication
daily were 51% more likely to be deceased at follow-up (hazard ratio [HR], 1.51).
Pain intensity and pain interference were not statistically significant.
Nonchronic pressure ulcer was related to 67% higher mortality risk (HR, 1.67),
and chronic pressure ulcer was related to 122% higher risk (HR, 2.22). Other
health indicators also increased the risk of mortality from 43% to 73%, including
hospitalization (HR, 1.54), depression (HR, 1.43), and amputation (HR, 1.73).
CONCLUSIONS: Prescription pain medication use appears to have a direct
association with mortality, beyond that associated with other characteristics,
and should become a strong focus of prevention efforts.
CI - Copyright (c) 2017 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS