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Abstract
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OBJECTIVE: To identify the relationships of pain intensity, pain interference, and pain medication use with risk of mortality after spinal cord injury (SCI), controlling for demographic, injury, socioeconomic, and health factors.
DESIGN: Prospective data collection occurred in 2007-2009 as part of a larger longitudinal study initiated in 1997-1998. Mortality status was determined as of December 31, 2014 using the National Death Index. A 3-stage Cox proportional hazards model was generated, with different sets of predictors entered at each step. SETTING: Academic medical center in Southeastern United States. PARTICIPANTS: All participants had traumatic SCI of at least 1-year duration at enrollment, with non-complete recovery (AIS A-D). Mortality status was obtained for 2,535 individuals, and 335 were deceased as of 2014. INTERVENTIONS: n/a MAIN OUTCOME MEASURE(S): Mortality status.
RESULTS: Preliminary bivariate analyses indicated deceased participants were more likely to be older at injury, have more years post injury, be male, and have a severe injury, low income, less education, and poorer health indicators. The final Cox model indicated those who used pain medication daily were 51% more likely to be deceased at follow-up (HR=1.51). Pain intensity and pain interference were not statistically significant. Non-chronic pressure sore was related to 67% higher mortality risk (HR=1.67), and chronic pressure sore 122% higher risk (HR=2.22). Other health indicators also increased the risk of mortality from 43%-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 relationship with mortality, beyond that associated with other characteristics, and should become a strong focus of prevention efforts.
Copyright © 2017. Published by Elsevier Inc.
Language: en |