Pain Intensity, Interference, and Medication Use After Spinal Cord Injury: Association With Risk of Mortality After Controlling for Socioeconomic and Other Health Factors.

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.