Spasticity and Pain after Spinal Cord Injury: Impact on Daily Life and the Influence of Psychological Factors

Background Spasticity and pain frequently co-occur in persons with spinal cord injury (SCI), yet, how these sequelae interact in daily life is unclear. Additionally, little is known about how psychological factors relate to the perception of spasticity and its impacts on daily life. Objectives (1) Characterize relationships between spasticity and chronic pain with regard to perceived severity, difficulty dealing, and life interference. (2) Determine the extent to which perceived spasticity severity and physiological, psychological, and pain-related factors contribute to impacts of spasticity on daily life (difficulty in dealing, life interference). (3) Determine the effects of painful spasticity on aspects of chronic pain and spasticity (severity, life interference, interference with sleep, and spasm duration). Design Observational study. Setting University laboratory. Participants Twenty participants with SCI and lower extremity spasticity. Methods Measures included International SCI Pain Basic Data Set, Pain and Spasticity Inventories, Difficulty Dealing with Pain/Spasticity, SCI-Spasticity Evaluation Tool, Connor-Davidson Resilience and Moorong Self-Efficacy Scales, Spinal Cord Assessment Tool for Spastic Reflexes, spasm duration, and injury-related and demographic factors. Bivariate correlations, multiple regression analyses, and pairwise comparisons were performed. Results Spasticity and chronic pain were directly related, with respect to perceived severity, difficulty dealing, and life interference (rho = 0.514-0.673, P < .05). Shorter injury duration, greater perceived spasticity severity, and greater difficulty dealing with pain explained 61% of variance in difficulty dealing with spasticity. Greater perceived spasticity severity and lower resilience explained 72% of variance in life interference of spasticity. Spasm duration was not significantly associated with perceived spasticity severity. Participants with painful spasticity had significantly greater chronic pain severity (P = .02) and sleep-related impact of spasticity (P = .03) than participants without painful spasticity. Conclusions Perceived severity of spasticity, injury duration, ability to deal with chronic pain, resilience, and painful spasms appear to play important roles in the negative impacts of spasticity on life after SCI. Level of Evidence III.