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STUDY DESIGN::A cross-sectional descriptive study of self-reported quality of sleep in individuals with a spinal cord injury (SCI). OBJECTIVES::To assess and describe subjective quality of sleep in patients with SCI, with and without pain. SETTING::Spinalis SCI unit, Stockholm, Sweden. METHODS::A total of 230 patients with an SCI were mailed a questionnaire containing queries about pain intensities, pain unpleasantness, mood, and sleep quality (Basic Nordic Sleep Questionnaire) to assess quality of sleep in patients with SCI with and without pain. RESULTS::Of the 192 questionnaires that were returned (response rate 83.4%), 191 were analysed. Patients were divided into three groups: (1) those who reported no pain (n=50), (2) those who reported intermittent pain (n=42), and (3) those who suffered from continuous pain (n=99). Patients suffering from continuous pain rated pain intensity and unpleasantness significantly higher than those who only suffered from intermittent pain. The group with continuous pain also reported the poorest quality of sleep and the highest ratings of anxiety and depression of the three groups. Anxiety, together with pain intensity and depression, were the main predictors for poor sleep quality. CONCLUSIONS::Poor subjective sleep quality was associated with higher ratings of pain intensity, anxiety, and depression. It is possible that melatonin serves as a modulator of these different aspects. SPONSORSHIP::This study was made possible by grants from Spinalis Foundation.Spinal Cord (2005) 43, 85-95. doi:10.1038/sj.sc.3101680; Published online 30 November 2004 [ABSTRACT FROM AUTHOR]

Objective: To assess whether a comprehensive multidisciplinary pain management programme could contribute to improvement regarding sleep quality, mood, life satisfaction, health-related quality of life, sense of coherence and pain for patients with a spinal cord injury and neuropathic pain., Design: A prospective intervention study., Patients: Twenty-seven patients with spinal cord injury and neuropathic pain participated in a pain management programme in parallel with 11 patients in a control group., Methods: A comprehensive pain management programme comprising educational, cognitive, and behavioural interventions was created for patients with spinal cord injury and neuropathic pain. The pain management programme consisted of 20 sessions over a 10-week period and included educational sessions, behavioural therapy, relaxation, stretching, light exercise and body awareness training. All patients were followed-up 3, 6 and 12 months after completion of the programme., Results: At the 12-month follow-up, levels of anxiety and depression in the treatment group decreased compared with baseline values, and a tendency towards better quality of sleep was seen. In comparison with the control group, patients in the treatment group improved regarding sense of coherence and depression., Conclusion: This study implies that a multidimensional pain management programme can be a valuable complement in the treatment of spinal cord injured patients with neuropathic pain.

Objective: This study set out to elucidate which factors are associated with or predictive for the use of analgesic drugs in patients with spinal cord injury and pain., Design: A cross-sectional descriptive study with a partly prospective cohort., Patients: One hundred and twenty-three patients with a spinal cord injury matched for gender, age, level of lesion and completeness of injury., Methods: Questionnaires consisting of ratings in the areas of pain intensities, pain unpleasantness, life satisfaction, anxiety and depression, and questions about consumption of analgesic drugs were posted to the 123 patients., Results: Of the 101 patients (82.1%) who returned the questionnaire, 90 (46 women and 44 men) still suffered from pain and were thus included in the study. Statistical analysis showed that although the number of pain medications used per person had increased in the last 3 years, the ratings of pain were unaffected. Logistic regression analyses also revealed that the use of pain-relieving medication was associated with higher ratings on the affective component of pain, lower ratings of leisure activities and the presence of stabbing/cutting pain., Conclusion: The affective component of pain is the main predictor for the use of analgesics in patients with a spinal cord injury. Complementary strategies, including a multidisciplinary approach, for relieving the unpleasantness of pain need to be explored further.

Objective: To describe pain and associated variables in a prevalence group of persons with a sustained spinal cord injury (SCI) in the Swedish capital and its surroundings., Setting: Spinalis SCI Unit (outpatient clinic), Stockholm, Sweden., Design: Assessment over a 12-month period in a yearly health control., Subjects: Four hundred and fifty-six SCI patients., Results: Two hundred and ninety-one out of 456 SCI patients (63.7%) suffered from pain, and in 45.7% of these it was classified as being neurogenic. Aching pain was the most used descriptor (38.5%). The onset of pain was commonly within three months (73.5%). In 70.4% of patients pain occurred below the level of the lesion. Most patients identified pain as coming from one (55.0%) or two (28.2%) body regions. Rating of the general pain intensity on a visual analogue scale (VAS) was 46 out of 100 and rating of the worst pain intensity was 78 out of 100. Ninety-four out of 276 patients (32.3%) considered that their quality of life was significantly affected by pain., Conclusion: Pain was most common in patients with incomplete lesions (ASIA impairment grade D) and there was a correlation between pain and higher mean age at injury and between pain and female gender.