Document Type : Original Article

Authors

1 Department of Research, Health, Rehabilitation, Integration, and Research Center (HRIR), Beirut, Lebanon Department of Physical Therapy, School of Public Health, Islamic University of Lebanon, Beirut, Lebanon Laboratory of Motor System, Handicap and Rehabilitation, School of Public Health, Lebanese University, Beirut, Lebanon

2 Department of Research, Health, Rehabilitation, Integration, and Research Center (HRIR), Beirut, Lebanon

3 Department of Physical Therapy, Faculty of Public Health, Islamic University of Lebanon, Beirut, Lebanon

4 Department of Physical Therapy, Faculty of Public Health, Islamic University of Lebanon, Beirut, Lebanon Laboratory of Motor System, Handicap and Rehabilitation, Faculty of Public Health, Lebanese University, Beirut, Lebanon

Abstract

Background: Chronic pain is one of the most disabling consequences of spinal cord injury (SCI). Although studies have identified a link between chronic pain and decreased quality of life (QOL) among this population, few studies have looked into the experience of chronic pain in Lebanese individuals with SCI and the impact of pain characteristics on QOL. Thus, the present study evaluated the chronic pain experience and its associated factors among Lebanese individuals with SCI in order to determine the impact of pain on QOL.
Methods: A cross-sectional study was conducted on 81 Lebanese individual with SCI between August 1st and October 31, 2022. The collected information included sociodemographic characteristics, SCI-related information, pain-related variables, and the 12-item Short Form Health Survey (SF-12). Factors associated with pain interference were evaluated using a linear regression model. One-way ANOVA and independent sample t-test were used to evaluate the association of different baseline and pain characteristics with QOL.
Results: In the present study, 81.5% of participants reported chronic pain with the majority of them having neuropathic pain type. Employment status (P = 0.034), type of pain (P = 0.009), and pain severity (P = 0.028) were significantly associated with pain interference. Unemployed participants and those with severe chronic pain, particularly neuropathic pain, had lower QOL.
Conclusion: Chronic pain was found to be highly prevalent among Lebanese patients with SCI. Pain interference and QOL were significantly affected by employment status and pain type. Therefore, targeting chronic pain and its associated factors in rehabilitation practice is warranted.

Keywords

  1. Bennett J, Emmady PD. Spinal cord injuries. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022.
  2. Hamid R, Averbeck MA, Chiang H, Garcia A, Al Mousa RT, Oh SJ, et al. Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury. World J Urol 2018; 36(10): 1517-27.
  3. Tate DG, Wheeler T, Lane GI, Forchheimer M, Anderson KD, Biering-Sorensen F, et al. Recommendations for evaluation of neurogenic bladder and bowel dysfunction after spinal cord injury and/or disease. J Spinal Cord Med 2020; 43(2): 141-64.
  4. Wecht JM, Harel NY, Guest J, Kirshblum SC, Forrest GF, Bloom O, et al. Cardiovascular autonomic dysfunction in spinal cord injury: Epidemiology, diagnosis, and management. Semin Neurol 2020; 40(5): 550-9.
  5. Courtois F, Charvier K. Sexual dysfunction in patients with spinal cord lesions. Handb Clin Neurol 2015; 130: 225-45.
  6. Tamburin S, Filippetti M, Mantovani E, Smania N, Picelli A. Spasticity following brain and spinal cord injury: Assessment and treatment. Curr Opin Neurol 2022; 35(6): 728-40.
  7. Hunt C, Moman R, Peterson A, Wilson R, Covington S, Mustafa R, et al. Prevalence of chronic pain after spinal cord injury: A systematic review and meta-analysis. Reg Anesth Pain Med 2021; 46(4): 328-36.
  8. Perrouin-Verbe B, Lefevre C, Kieny P, Gross R, Reiss B, Le FM. Spinal cord injury: A multisystem physiological impairment/dysfunction. Rev Neurol (Paris) 2021; 177(5): 594-605.
  9. Andresen SR, Biering-Sorensen F, Hagen EM, Nielsen JF, Bach FW, Finnerup NB. Pain, spasticity and quality of life in individuals with traumatic spinal cord injury in Denmark. Spinal Cord 2016; 54(11): 973-9.
  10. Tulsky DS, Kisala PA, Victorson D, Tate DG, Heinemann AW, Charlifue S, et al. Overview of the Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system. J Spinal Cord Med 2015; 38(3): 257-69.
  11. Kreuter M, Siosteen A, Erkholm B, Bystrom U, Brown DJ. Health and quality of life of persons with spinal cord lesion in Australia and Sweden. Spinal Cord 2005; 43(2): 123-9.
  12. Post MW. Definitions of quality of life: What has happened and how to move on. Top Spinal Cord Inj Rehabil 2014; 20(3): 167-80.
  13. Trgovcevic S, Milicevic M, Nedovic G, Jovanic G. Health condition and quality of life in persons with spinal cord injury. Iran J Public Health 2014; 43(9): 1229-38.
  14. Yazdanshenas Ghazwin M, Chaibakhsh S, Latifi S, Tavakoli A H, Koushki D. Quality of life in Iranian men with spinal cord injury in comparison with general population. Arch Neurosci 2015; 2(2): e21529.
  15. Lude P, Kennedy P, Elfstrom ML, Ballert CS. Quality of life in and after spinal cord injury rehabilitation: A longitudinal multicenter study. Top Spinal Cord Inj Rehabil 2014; 20(3): 197-207.
  16. Duan R, Qu M, Yuan Y, Lin M, Liu T, Huang W, et al. Clinical benefit of rehabilitation training in spinal cord injury: A systematic review and meta-analysis. Spine (Phila Pa 1976) 2021; 46(6): E398-E410.
  17. Quel de Oliveira C, Refshauge K, Middleton J, de Jong L, Davis GM. Effects of activity-based therapy interventions on mobility, independence, and quality of life for people with spinal cord injuries: A systematic review and meta-analysis. J Neurotrauma 2017; 34(9): 1726-43.
  18. Sturm C, Gutenbrunner CM, Egen C, Geng V, Lemhofer C, Kalke YB, et al. Which factors have an association to the Quality of Life (QoL) of people with acquired Spinal Cord Injury (SCI)? A cross-sectional explorative observational study. Spinal Cord 2021; 59(8): 925-32.
  19. Lee JS, Kim SW, Jee SH, Kim JC, Choi JB, Cho SY, et al. Factors affecting quality of life among spinal cord injury patients in Korea. Int Neurourol J 2016; 20(4): 316-20.
  20. Halvorsen A, Pape K, Post MWM, Biering-Sorensen F, Mikalsen S, Hansen AN, et al. Participation and quality of life in persons living with spinal cord injury in Norway. J Rehabil Med 2021; 53(7): jrm00217.
  21. Zwecker M, Heled E, Bluvstein V, Catz A, Bloch A, Zeilig G. Assessment of the unmediated relationship between neurological impairment and health-related quality of life following spinal cord injury. J Spinal Cord Med 2022; 45(2): 293-300.
  22. Ebrahimzadeh MH, Soltani-Moghaddas SH, Birjandinejad A, Omidi-Kashani F, Bozorgnia S. Quality of life among veterans with chronic spinal cord injury and related variables. Arch Trauma Res 2014; 3(2): e17917.
  23. Tavakoli SA, Kavian M, Bakhsh SC, Ghajarzadeh M, Hamedan MS, Ghazwin MY, et al. Is Level of injury a determinant of quality of life among individuals with spinal cord injury? A Tertiary Rehabilitation Center Report. Oman Med J 2016; 31(2): 112-6.
  24. Norrbrink BC, Hultling C, Lundeberg T. Quality of sleep in individuals with spinal cord injury: A comparison between patients with and without pain. Spinal Cord 2005; 43(2): 85-95.
  25. Nicholson PK, Nicholas MK, Middleton J. Spinal cord injury-related pain in rehabilitation: A cross-sectional study of relationships with cognitions, mood and physical function. Eur J Pain 2009; 13(5): 511-7.
  26. Craig A, Tran Y, Siddall P, Wijesuriya N, Lovas J, Bartrop R, et al. Developing a model of associations between chronic pain, depressive mood, chronic fatigue, and self-efficacy in people with spinal cord injury. J Pain 2013; 14(9): 911-20.
  27. Taran S, Conti J, Routhier F, Latimer-Cheung AE, Noreau L, Sweet SN. Leisure time physical activity, perception of impact of pain and life satisfaction after spinal cord injury. Ann Phys Rehabil Med 2018; 61(4): 273-5.
  28. Ullrich PM, Jensen MP, Loeser JD, Cardenas DD. Pain intensity, pain interference and characteristics of spinal cord injury. Spinal Cord 2008; 46(6): 451-5.
  29. Widerstrom-Noga EG, Finnerup NB, Siddall PJ. Biopsychosocial perspective on a mechanisms-based approach to assessment and treatment of pain following spinal cord injury. J Rehabil Res Dev 2009; 46(1): 1-12.
  30. Masri R, Keller A. Chronic pain following spinal cord injury. Adv Exp Med Biol 2012; 760: 74-88.
  31. Scholz J, Finnerup NB, Attal N, Aziz Q, Baron R, Bennett MI, et al. The IASP classification of chronic pain for ICD-11: Chronic neuropathic pain. Pain 2019; 160(1): 53-9.
  32. Burke D, Fullen BM, Stokes D, Lennon O. Neuropathic pain prevalence following spinal cord injury: A systematic review and meta-analysis. Eur J Pain 2017; 21(1): 29-44.
  33. Jensen MP, Hoffman AJ, Cardenas DD. Chronic pain in individuals with spinal cord injury: A survey and longitudinal study. Spinal Cord 2005; 43(12): 704-12.
  34. Rintala DH, Hart KA, Priebe MM. Predicting consistency of pain over a 10-year period in persons with spinal cord injury. J Rehabil Res Dev 2004; 41(1): 75-88.
  35. Norrbrink BC, Lund I, Hultling C, Levi R, Werhagen L, Ertzgaard P, et al. Gender related differences in pain in spinal cord injured individuals. Spinal Cord 2003; 41(2): 122-8.
  36. Nicholson PK, Nicholas MK, Middleton J, Siddall P. Psychological characteristics of people with spinal cord injury-related persisting pain referred to a tertiary pain management center. J Rehabil Res Dev 2009; 46(1): 57-67.
  37. Khazaeipour Z, Ahmadipour E, Rahimi-Movaghar V, Ahmadipour F, Vaccaro AR, Babakhani B. Association of pain, social support and socioeconomic indicators in patients with spinal cord injury in Iran. Spinal Cord 2017; 55(2): 180-6.
  38. Muller R, Brinkhof MW, Arnet U, Hinrichs T, Landmann G, Jordan X, et al. Prevalence and associated factors of pain in the Swiss spinal cord injury population. Spinal Cord 2017; 55(4): 346-54.
  39. Rekand T, Hagen EM, Gronning M. Chronic pain following spinal cord injury. Tidsskr Nor Laegeforen 2012; 132(8): 974-9.
  40. Jang JY, Lee SH, Kim M, Ryu JS. Characteristics of neuropathic pain in patients with spinal cord injury. Ann Rehabil Med 2014; 38(3): 327-34.
  41. Turner JA, Cardenas DD, Warms CA, McClellan CB. Chronic pain associated with spinal cord injuries: A community survey. Arch Phys Med Rehabil 2001; 82(4): 501-9.
  42. Hagen EM, Rekand T. Management of neuropathic pain associated with spinal cord injury. Pain Ther 2015; 4(1): 51-65.
  43. Dijkers M, Bryce T, Zanca J. Prevalence of chronic pain after traumatic spinal cord injury: A systematic review. J Rehabil Res Dev 2009; 46(1): 13-29.
  44. Li C, DiPiro ND, Clark JMR, Krause JS. Mediating effects of pain interference on the relationships between pain intensity and probable major depression among participants with spinal cord injury. Arch Phys Med Rehabil 2022; 103(4): 747-54.
  45. Finnerup NB. Pain in patients with spinal cord injury. Pain 2013; 154(Suppl 1): S71-S76.
  46. Burke D, Lennon O, Fullen BM. Quality of life after spinal cord injury: The impact of pain. Eur J Pain 2018; 22(9): 1662-72.
  47. Nagoshi N, Kaneko S, Fujiyoshi K, Takemitsu M, Yagi M, Iizuka S, et al. Characteristics of neuropathic pain and its relationship with quality of life in 72 patients with spinal cord injury. Spinal Cord 2016; 54(9): 656-61.
  48. Ord AS, Lad SS, Shura RD, Rowland JA, Taber KH, Martindale SL. Pain interference and quality of life in combat veterans: Examining the roles of posttraumatic stress disorder, traumatic brain injury, and sleep quality. Rehabil Psychol 2021; 66(1): 31-8.
  49. Nasidi MA, Akindele MO, Ibrahim AA, Ahmad AA, Musa A. Health-related quality of life and related characteristics of persons with spinal cord injury in Nigeria. Iran J Neurol 2019; 18(2): 50-6.
  50. Williams JR. The Declaration of Helsinki and public health. Bull World Health Organ 2008; 86(8): 650-2.
  51. Ballout S, Noureddine S, Huijer HA, Kanazi G. Psychometric evaluation of the arabic brief pain inventory in a sample of Lebanese cancer patients. J Pain Symptom Manage 2011; 42(1): 147-54.
  52. Chatila N, Pereira B, Maarrawi J, Dallel R. Validation of a new Arabic version of the Neuropathic Pain Diagnostic Questionnaire (DN4). Pain Pract 2017; 17(1): 78-87.
  53. Haddad C, Sacre H, Obeid S, Salameh P, Hallit S. Validation of the Arabic version of the "12-item short-form health survey" (SF-12) in a sample of Lebanese adults. Arch Public Health 2021; 79(1): 56.
  54. Cleeland CS, Ryan KM. Pain assessment: Global use of the Brief Pain Inventory. Ann Acad Med Singap 1994; 23(2): 129-38.
  55. Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS. Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004; 20(5): 309-18.
  56. Finnerup NB, Jensen MP, Norrbrink C, Trok K, Johannesen IL, Jensen TS, et al. A prospective study of pain and psychological functioning following traumatic spinal cord injury. Spinal Cord 2016; 54(10): 816-21.
  57. Hand BN, Velozo CA, Krause JS. Measuring the interference of pain on daily life in persons with spinal cord injury: A Rasch-validated subset of items from the Brief Pain Inventory interference scale. Aust Occup Ther J 2018; 65(5): 405-11.
  58. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005; 114(1-2): 29-36.
  59. Timmerman H, Steegers MAH, Huygen FJPM, Goeman JJ, van Dasselaar NT, Schenkels MJ, et al. Investigating the validity of the DN4 in a consecutive population of patients with chronic pain. PLoS One 2017; 12(11): e0187961.
  60. Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34(3): 220-33.
  61. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: Results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51(11): 1171-8.
  62. Hagell P, Westergren A. Measurement properties of the SF-12 health survey in Parkinson's disease. J Parkinsons Dis 2011; 1(2): 185-96.
  63. Arovah NI, Heesch KC. Assessment of the validity and reliability of the Indonesian version of Short Form 12 (SF-12). J Prev Med Hyg 2021; 62(2): E421-9.
  64. Felix ER, Cardenas DD, Bryce TN, Charlifue S, Lee TK, MacIntyre B, et al. Prevalence and impact of neuropathic and nonneuropathic pain in chronic spinal cord injury. Arch Phys Med Rehabil 2022; 103(4): 729-37.
  65. van Gorp S, Kessels AG, Joosten EA, van Kleef M, Patijn J. Pain prevalence and its determinants after spinal cord injury: A systematic review. Eur J Pain 2015; 19(1): 5-14.
  66. Siddall PJ, McClelland JM, Rutkowski SB, Cousins MJ. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain 2003; 103(3): 249-57.
  67. Jensen MP, Tome-Pires C, de la V, Galan S, Sole E, Miro J. What determines whether a pain is rated as mild, moderate, or severe? the importance of pain beliefs and pain interference. Clin J Pain 2017; 33(5): 414-21.
  68. Burke D, Fullen BM, Lennon O. Pain profiles in a community dwelling population following spinal cord injury: a national survey. J Spinal Cord Med 2019; 42(2): 201-11.
  69. Mugoya GC, Hooper LM, Tomek S, George DS, Bolland A, Ufomadu J, et al. The interrelationships among pain interference, depressive symptoms, loneliness, and employment status: A moderated mediation study. Clin Rehabil 2018; 32(7): 967-79.
  70. Teasell RW, Bombardier C. Employment-related factors in chronic pain and chronic pain disability. Clin J Pain 2001; 17(4 Suppl): S39-S45.
  71. Hu Y, Mak JN, Wong YW, Leong JC, Luk KD. Quality of life of traumatic spinal cord injured patients in Hong Kong. J Rehabil Med 2008; 40(2): 126-31.
  72. Moghimian M, Kashani F, Cheraghi MA, Mohammadnejad E. Quality of Life and Related Factors Among People With Spinal Cord Injuries in Tehran, Iran. Arch Trauma Res 2015; 4(3): e19280.
  73. Geyh S, Ballert C, Sinnott A, Charlifue S, Catz A, D'Andrea Greve JM, et al. Quality of life after spinal cord injury: A comparison across six countries. Spinal Cord 2013; 51(4): 322-6.
  74. Khazaeipour Z, Taheri-Otaghsara SM, Naghdi M. Depression following spinal cord injury: Its relationship to demographic and socioeconomic indicators. Top Spinal Cord Inj Rehabil 2015; 21(2): 149-55.
  75. Saadat S, Javadi M, Divshali BS, Tavakoli AH, Ghodsi SM, Montazeri A, et al. Health-related quality of life among individuals with long-standing spinal cord injury: A comparative study of veterans and non-veterans. BMC Public Health 2010; 10: 6.
  76. Sabour H, Soltani Z, Latifi S, Norouzi-Javidan A, Arman F, Emami-Razavi SH, et al. Injury-related characteristics and quality-of-life among Iranian individuals with spinal cord injury. Iran J Neurol 2015; 14(3): 136-41.
  77. Gurcay E, Bal A, Eksioglu E, Cakci A. Quality of life in patients with spinal cord injury. Int J Rehabil Res 2010; 33(4): 356-8.
  78. Ataoglu E, Tiftik T, Kara M, Tunc H, Ersoz M, Akkus S. Effects of chronic pain on quality of life and depression in patients with spinal cord injury. Spinal Cord 2013; 51(1): 23-6.
  79. Karayannis NV, Sturgeon JA, Chih-Kao M, Cooley C, Mackey SC. Pain interference and physical function demonstrate poor longitudinal association in people living with pain: A PROMIS investigation. Pain 2017; 158(6): 1063-8.
  80. Suso-Ribera C, Camacho-Guerrero L, Osma J, Suso-Vergara S, Gallardo-Pujol D. A Reduction in pain intensity is more strongly associated with improved physical functioning in frustration tolerant individuals: A longitudinal moderation study in chronic pain patients. Front Psychol 2019; 10: 907.
  81. Alschuler KN, Jensen MP, Sullivan-Singh SJ, Borson S, Smith AE, Molton IR. The association of age, pain, and fatigue with physical functioning and depressive symptoms in persons with spinal cord injury. J Spinal Cord Med 2013; 36(5): 483-91.
  82. Modirian E, Pirouzi P, Soroush M, Karbalaei-Esmaeili S, Shojaei H, Zamani H. Chronic pain after spinal cord injury: Results of a long-term study. Pain Med 2010; 11(7): 1037-43.
  83. Cuff L, Fann JR, Bombardier CH, Graves DE, Kalpakjian CZ. Depression, pain intensity, and interference in acute spinal cord injury. Top Spinal Cord Inj Rehabil 2014; 20(1): 32-9.
  84. Richardson EJ, Brooks LG, Richards JS, Bombardier CH, Barber J, Tate D, et al. Changes in pain and quality of life in depressed individuals with spinal cord injury: Does type of pain matter? J Spinal Cord Med 2016; 39(5): 535-43.
  85. Sunna T, Elias E, Summaka M, Zein H, Elias C, Nasser Z. Quality of life among men with spinal cord injury in Lebanon: A case control study. NeuroRehabilitation 2019; 45(4): 547-53.
  86. International Labour Organization. Emerging good practices related to training and job placement of persons with disabilities in lebanon. Beirut, Lebanon: International Labour Organization, Regional Office for Arab States; 2013.
  87. Combaz E. Situation of persons with disabilities in Lebanon. Brighton, UK: Institute of Development Studies; 2018.
  88. Summaka M, Zein H, Naim I, Fneish S. Assessing the psychological impact of COVID-19 outbreak and its related factors on Lebanese individuals with physical disabilities. Disabil Health J 2021; 14(3): 101073.