@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2016;8(2):105-110

Background
Spinal cord injury is a severe accident that has unpredictable consequences for suffered individual, family, friends and society [1].
Previous Studies
… [1-4]. Suffering from spinal cord injury creates a lot of complications, but pain is being raised as one of the worst and most debilitating problems in these patients [5]. … [6-10]. People with spinal cord injuries may experience one or more types of pain at the same time that sometimes it reaches to the extent of seven different types of pains [11, 12]. … [13-17].
Aim(s)
The aim of conducting this study was investigating the prevalence and severity of different kinds of pains in patients with spinal cord injury who visited Khatam Alanbiya's hospital in Tehran.
Research type
This study is sectional descriptive-analytic.
Research society, place and time
This study was conducted on all the patients with spinal cord injury who visited Khatam Alanbiya's hospital in Tehran.
Sampling method and number
With using the Cochran formula and sampling based on the aim, 248 patients entered the study who had visited the spinal cord section of the hospital in the first 6 months of the year 2015 and were willing to participate in the study.
Used devices&materials
To gather data, the demographic properties questionnaire (that had questions about age, marital status, educational level, infection reason, and injury type, the date of beginning of the pain and body mass index) and international questionnaire of basic pains in patients with spinal cords were used. The international questionnaire of basic pains of patients with spinal cords injuries was designed by a group of specialists in spinal cords pain, psychiatrist, psychologist and epidemiologists and a representative from international community of spinal cord injuries under the supervision of four valid organizations including international community of spinal cord, the American community of spinal cord injury, American community of pain and international community of pain studies. The first version of it was designed in 2006 in Copenhagen in Denmark and then in 2010 it was changed to self-reported method by Johnson. The questionnaire has 15 questions and four parts that specifies pain types, pain location, pain effects and severity and time pattern of the pain. 13 of these questions is being repeated for each pain with special feature [18]. The different kinds of pain part has 3 questions that one of this questions examines having and not having the pain and is being answered with yes and no. the other question specifies one type of the pain with special features to five types and more and one important question choses between one of the unknown non-nerve and nerve pains. The pain location part with one question shows the existence of the pain in different parts of the body. The severity and time pattern of pain with 4 questions specifies the pain severity (zero to 10), the severity pain in week days, the pain duration and the time of the climax of the pain. The pain effects part includes 6 seven-choice questions about the sleeping quality, life enjoyment, satisfaction, recreation, the ability of doing life daily activities and doing the job and from zero to 6 shows the pain effects on patient's life and one question specifies using and not using the treatment to reduce the pain[19]. The validity and reliabiltiy of international questionnaire of basic pains of spinal cords injuries was examined by Johnson et al. in 2010 on 184 patients suffering from spinal cords injuries and its Cronbach's alpha coefficient was reported 0.94 and inward class correlation coefficient (ICC) 0.91[20] . Its content and face validity were examined and confirmed by Sedghgoy Aghaj et al on 25 persons including 10 specialists and 15 patients of spinal cords injury. Also, its reliability was evaluated by Cronbach's alpha coefficient and inner correlation (IC) 0.93 in upper level [19] . The data after gathering were entered in SPSS 19 software and were analyzed with using the descriptive statistics (calculation of the frequency, the percentage of the frequency, mean and standard deviation) and inferential statistics. At first, the normality of data distribution was examined by using the Cologrof-Smirnof statistical test that the results showed the normality of the data. Then the independent T-test was used to compare the variables between two genders, the Pearson correlation test was used for specifying the relationship between age and the severity of different kinds of pain and one-way analysis of variance (ANOVA) to compare the intensity of different types of pain based on demographic variables.
Findings by Text
The participating patients were 248 persons who mostly were men, married and they had diploma. The mean age of patients was 42.00± 11.3 years and their mean body mass scale was 32.4± 4.52 Kilograms per square meter. The reason for spinal cord injury in these patients in order of frequency was war, car accident, falling from height and spinal cord tumors. 60.08% of patients were injured in thoracic vertebra (C1-C12) and most of them (70.1%) stated that their pain was started immediately after the spinal cord injury (Table 1). Only 6 persons (2.41%) of patients stated that they did not have pain and 242 persons (97.59%) mentioned one or more pains. The neuropathic pain was the most prevailing pain among these people and musculoskeletal and visceral pains were in next ranks in terms of prevalence. The most severe pain in patients respectively was neuropathic, musculoskeletal and visceral pains (Table 2). People who had neuropathic pain, almost all parts of body was in pain and generally, most organs, which were in pain, were the neck and shoulder (Table 3). Neuropathic pain in 81.85% and musculoskeletal pain in 73.24% of cases were in the level of the injury and lower. In terms of the neuropathic pain, 74.19% of patients stated that they had pain during the last 7 days and 66.53% had the pain continuously and permanently in terms of pain duration that the pain intensity became more at nights (from 24 to 6 in the morning) for most of the patients (53.22%) and in 28.22% of cases there was no special time function during the day. About musculoskeletal pain, 45.96% stated that during last week, they have had pain for 4 days and 56.04% mentioned the pain duration between 1-24 hours that there was no time function of the pain intensifying for most patients (39.91%). About visceral pain, 41.53% of patients had pain in all the 7 days of the week and 73.38% said the pain duration was between 1-60 minutes. Also in this case, there was no time function for these patients (87.9%) for pain intensifying. The mean score of the effect on people's lives in people with neuropathic pain was 3.79± 0.60, in people with musculoskeletal pain 3.21±0.68 and in people with visceral pain 1.21±0.39. Also, 74.19% of patients were using medical and nonmedical treatment for their pain that the used treatment was medical treatment (Gabapentin, Pregabalin, and Baclofen) mostly. There was a meaningful relationship only between gender and pain severity and the mean musculoskeletal pain severity in women (7.12±2.80) was meaningfully more than men (5.93±0.72) (P=0.018). There was no meaningful relationship (p>0.05) between pain severity and other demography patient's properties.
Main comparison to the similar studies
The findings shows the high prevalence of different kinds of pains after suffering from spinal cords injury that its prevalence is higher in different studies (between 11% and 96%) [6, 11, 21]. … [22]. In terms of pain severity, the current study results indicates the severity of these pains specially neuropathic pain and is aligned with the order of pain severity in other studies [23-26]…[27-31].
Suggestions
Non-declared
Limitations
Of limitations of this study the low number of participating women can be mentioned. Also, mental perception of the pain that is different between different people can affect the gain results.
Conclusions
The pain in spinal cords injury patients is prevalent and mostly severe. Neuropathic pain is the most common and severe pain of its kind and musculoskeletal and visceral pains are in next levels.
Acknowledgments
We show our extreme thanks to the respectful research management and adjutancy of Khatam Alanbiya hospital of Tehran and the friendly cooperation of the respectful nursery manager and patients.
Conflict of interest
Non-declared
Ethical Permissions
In order to comply with ethics in the study, an informed consent was taken from all the patients and it was explained to them that there was no need to mention the first and last name. Participating in the study was completely optional and had no effect on their treatment procedure.
Funding Sources
This study is part of a researching project with approved number 94-14 at 5/6/2015 in Shafa nerve science research center of Khatam Alanbiya hospital of Tehran.

TABLES and CHARTS

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