Cut point determination in the measurement of pain and its relationship to psychosocial and functional measures after traumatic spinal cord injury: A retrospective model spinal cord injury system analysis

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Study evaluated potential pain cutoff scores reflecting mild, moderate, and severe pain in the spinal cord injury (SCI) population and determined the relationship between the derived cutoff scores and both psychosocial and functional outcome measures. The data analyzed were extracted from the SCI Model Systems database for 6,096 adults with American Spinal Injury Association Impairment Scale (AIS) grades A through D. Outcome measures included: a numeric rating scale (NRS) of pain severity, a NRS of pain interference, the Satisfaction With Life Scale, the Patient Health Questionnaire-9, the Craig Handicap Assessment and Reporting Technique Short-Form (CHART-SF), the motor component of the Functional Independence Measure (FIM-motor), and employment. Analysis revealed that the best set of pain severity cutoff points are 1 to 3, 4 to 6, and 7 to 10. This was validated by randomly assigning sample members to 2 groups and replicating. There were significant differences in all outcomes as a function of pain severity grouping, although they explained little of the variance in FIM-motor and CHART-SF Physical Independence scale scores. Neurologic status differed significantly between pain groups, with incongruence between pain severity and interference in people in the AIS grade D group, who reported the greatest pain interference and least pain severity. These groupings differentiate psychosocial well-being better than activity limitations. They do not provide a comprehensive pain assessment, for which pain type, location, and interference are likely to be necessary.

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