• Bianca F Marcondes, Shruti Sreepathi, Justin Markowski, Dung Nguyen, Shannon R Stock, Sandra Carvalho, Denise Tate, Ross Zafonte, Leslie R Morse, and Felipe Fregni.
• Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA - felipe.fregni@ppcr.hms.harvard.edu.
• Eur J Phys Rehabil Med. 2016 Oct 1; 52 (5): 630-636.

BackgroundFollowing a spinal cord injury, patients are often burdened by chronic pain. Preliminary research points to activation of the motor cortex through increased mobility as a potential means of alleviating postinjury chronic pain.AimThe aim of this study was to assess the relationship between pain severity and mobility among patients who have sustained a traumatic spinal cord injury while controlling for clinically-relevant covariates.DesignA multi-center, cross-sectional study.SettingThe SCIMS is composed of 14 centers, all located in the United States and funded by the National Institute on Disability and Rehabilitation Research (NIDRR).PopulationThe study cohort included 1980 patients who completed the one-year SCIMS follow-up assessment between October 2000- December 2013.MethodsA multi-center, cross-sectional study was performed to assess the impact of mobility on self-reported pain using information from 1980 subjects who sustained a traumatic spinal cord injury and completed a year-one follow-up interview between October 2000 and December 2013. Patient information was acquired using the Spinal Cord Injury National Database, compiled by the affiliated Spinal Cord Injury Model Systems. Analyses included a multivariable linear regression of patients' self-reported pain scores on mobility, quantified using the CHART-SF mobility total score, and other clinically relevant covariates.ResultsAfter controlling for potential confounders, a significant quadratic relationship between mobility and patients' self-reported pain was observed (P=0.016). Furthermore, female gender, "unemployed" occupational status, paraplegia, and the presence of depressive symptoms were associated with significantly higher pain scores (P<0.02 for all variables). Statistically significant quadratic associations between pain scores and age at injury, life satisfaction total score, and the CHART-SF occupational total subscale were also observed (P≤0.03 for all variables).ConclusionsAmong patients with moderate to high levels of mobility, pain scores decreased with increasing mobility.Clinical Rehabilitation ImpactEnhancing a patient's physical activity by increasing his or her mobility may reduce neuropathic pain if begun shortly after a spinal cord injury.

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