James S Krause1, Yue Cao2, Jillian M R Clark2. 1. College of Health Professions, Medical University of South Carolina, Charleston, SC. Electronic address: krause@musc.edu. 2. College of Health Professions, Medical University of South Carolina, Charleston, SC.
Abstract
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.
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.
Authors: Charles H Bombardier; Casey B Azuero; Jesse R Fann; Donald D Kautz; J Scott Richards; Sunil Sabharwal Journal: Top Spinal Cord Inj Rehabil Date: 2021
Authors: Andrew D Gaudet; Laura K Fonken; Monica T Ayala; Steven F Maier; Linda R Watkins Journal: Brain Behav Immun Date: 2021-07-17 Impact factor: 19.227