Objective

To evaluate whether pain interference mediates the relationship between pain intensity and probable major depression (PMD) among persons with spinal cord injury (SCI), accounting for differences in the frequency of prescription medication use and resilience.

Design

Cross-sectional analysis using self-report assessment.

Setting

Medical university in the Southeastern United States.

Participants

There were a total of 4670 participants (N=4670), all of whom had traumatic SCI of at least 1-year duration, identified from the Southeastern Regional SCI Model System and 2 state-based surveillance systems.

Interventions

Not applicable.

Main Outcome Measures

The Patient Health Questionnaire-9 was used to define PMD. Covariates included demographic and injury characteristics, pain severity, pain interference, and resilience. Separate sets of multistage logistic regression analyses were conducted for 3 levels of prescription pain medication use (daily, occasional/weekly, none).

Results

Pain intensity was related to a greater risk of PMD (odds ratio [OR]_{daily pain medication user}, 1.28; 95% confidence interval [CI], 1.21-1.35; OR_{occasional/weekly pain medication user}, 1.26; 95% CI, 1.16-1.36; OR_{nonpain medication user}, 1.44; 95% CI, 1.33-1.56), but this relationship disappeared after consideration of pain interference (OR_{daily pain medication user}, 0.97; 95% CI, 0.90-1.04; OR_{occasional/weekly pain medication user}, 0.94; 95% CI, 0.84-1.05; OR_{nonpain medication user}, 1.07; 95% CI, 0.95-1.20), which indicates pain interference was a mediator between pain intensity and PMD and there was no direct relationship between pain intensity and PMD. Resilience was protective of PMD in each model but was not a mediator.

Conclusions

Although pain intensity was associated with PMD, the relationship was mediated by pain interference. Resilience was an important protective factor. Therefore, clinicians should assess pain interference when screening for PMD and direct treatment at reducing pain interference. Building resilience may further reduce the risk of PMD.

中文翻译：

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疼痛干预对脊髓损伤参与者疼痛强度与可能重度抑郁之间关系的中介作用

客观的

评估疼痛干扰是否介导脊髓损伤 (SCI) 患者的疼痛强度与可能的重度抑郁症 (PMD) 之间的关系，解释处方药使用频率和恢复力的差异。

设计

使用自我报告评估进行横断面分析。

环境

美国东南部的医科大学。

参与者

共有 4670 名参与者（N=4670），他们都患有至少 1 年的创伤性 SCI，从东南地区 SCI 模型系统和 2 个基于州的监测系统中确定。

干预措施

不适用。

主要观察指标

患者健康问卷 9 用于定义 PMD。协变量包括人口统计学和损伤特征、疼痛严重程度、疼痛干扰和复原力。对 3 个级别的处方止痛药使用（每日、偶尔/每周、无）进行了单独的多阶段逻辑回归分析。

结果

疼痛强度与 PMD 的更大风险相关（比值比 [OR]_{每日使用止痛药}，1.28；95% 置信区间 [CI]，1.21-1.35；或_{偶尔/每周使用止痛药}，1.26；95% CI，1.16 -1.36；_{或非止痛药使用者}，1.44；95% CI，1.33-1.56），但在考虑疼痛干扰后，这种关系消失了（或_{每日止痛药使用者}，0.97；95% CI，0.90-1.04；或_{偶尔/每周疼痛药物使用者}，0.94；95% CI，0.84-1.05；_{或非疼痛药物使用者}, 1.07; 95% CI, 0.95-1.20)，表明疼痛干扰是疼痛强度与 PMD 之间的中介，而疼痛强度与 PMD 之间没有直接关系。在每个模型中，复原力对 PMD 有保护作用，但不是中介。

结论

尽管疼痛强度与 PMD 相关，但这种关系是由疼痛干扰介导的。复原力是一个重要的保护因素。因此，临床医生在筛查 PMD 时应评估疼痛干扰，并直接治疗以减少疼痛干扰。建立复原力可能会进一步降低 PMD 的风险。