Cairns D M, Adkins R H, Scott M D
Clinical Psycology, Rancho Los Amigos Medical Center, Downey, CA, USA.
Arch Phys Med Rehabil. 1996 Apr;77(4):329-35. doi: 10.1016/s0003-9993(96)90079-9.
To examine the relationship between pain and depression over time during acute phases of traumatic spinal cord injury (SCI). Theoretical models of the pain-depression relationship provided the framework: (1) pain causes depression; (2) depression causes pain; (3) pain and depression are independent sequelae to SCI. Understanding the pain-depression relationship provides treatment implications and hypotheses for origins of chronic pain in SCI.
A repeated measures design assessing subjects at admission and discharge from rehabilitation.
Subjects were admitted to a large public hospital in Southern California which is a member of the Model Spinal Cord Injury System. Rehabilitation occurred on two 30-bed units.
Complete admission and discharge data sets were collected from 68 acute traumatic SCI patients who served as subjects. One hundred twenty-one patients initially agreed to participate in a larger study of adjustments to SCI. Thirty-three did not have pain data at admission, 16 dropped out, and 4 had incomplete discharge data. Subjects volunteered and were paid a fee.
A standard rehabilitation program for SCI.
Pain assessment used a 101-point numerical rating scale. Depression assessment used the Center for Epidemiological Studies-Depression Scale(CESD).
Pain and depression were independent at admission. At discharge, they were significantly related. Changes in pain affected depression more than changes in depression affected pain.
Relationships between pain and depression develop over time. Reduced pain will have a greater effect on reducing depression than reduced depression will have on pain. Pain described as "burning" during the acute phase does not represent difficult to treat dysesthetic pain, as it may in chronic SCI pain.
探讨创伤性脊髓损伤（SCI）急性期疼痛与抑郁随时间的关系。疼痛 - 抑郁关系的理论模型提供了框架：（1）疼痛导致抑郁；（2）抑郁导致疼痛；（3）疼痛和抑郁是SCI的独立后遗症。了解疼痛 - 抑郁关系可为SCI慢性疼痛的起源提供治疗启示和假设。
采用重复测量设计，在康复入院和出院时对受试者进行评估。
受试者入住南加州一家大型公立医院，该医院是脊髓损伤示范系统的成员。康复在两个拥有30张床位的病房进行。
从68例急性创伤性SCI患者中收集了完整的入院和出院数据集，这些患者作为研究对象。121例患者最初同意参与一项关于SCI适应情况的更大规模研究。33例患者入院时没有疼痛数据，16例退出，4例出院数据不完整。受试者为自愿参与并获得报酬。
针对SCI的标准康复计划。
疼痛评估采用101分数字评分量表。抑郁评估采用流行病学研究中心抑郁量表（CESD）。
入院时疼痛和抑郁是独立的。出院时，它们显著相关。疼痛的变化对抑郁的影响大于抑郁的变化对疼痛的影响。
疼痛与抑郁的关系随时间发展。疼痛减轻对抑郁减轻的影响大于抑郁减轻对疼痛的影响。急性期描述为“灼痛”的疼痛并不像慢性SCI疼痛那样代表难以治疗的感觉异常性疼痛。
