Trajectories and characteristics of pain in the first year after spinal cord injury: a TRACK-SCI study
- 1Weill Institute for Neurosciences, Brain and Spinal Injury Center (BASIC), University of California San Francisco (UCSF), San Francisco, CA, USA
Abstract
Chronic pain affects most individuals with spinal cord injury (SCI) and frequently impairs daily function, and nearly half experience neuropathic pain. Neuropathic pain is commonly thought to develop months after injury and to persist once established. These views rest on classifying each patient as having neuropathic pain or not, although patients often report several pains. The same binary label is the usual target of prognostic and biomarker studies that aim to predict life-limiting pain. We tracked up to three of the worst pains per interview from injury to one year in 140 TRACK-SCI participants, using the DN4 interview (DN4i, threshold 3). Within three days of injury, half of all pain areas and three quarters of participants met the threshold, and pain-area prevalence changed little over the year. Individual pains, however, often changed. Only a third remained above the threshold throughout, one third resolved or fluctuated, and pains in the same person often followed different courses. At more than half of interviews with several pains, one pain met the threshold while another did not, so that the patients classification depended on the pain considered. We therefore derived a threshold-free Pain Composite Score from the DN4i items and pain intensity. The items formed a single dimension, and the composite was associated with sleep and mood interference whereas the binary classification was not. Neuropathic pain after SCI thus appears early, does not invariably persist, and differs between a persons pains, and graded pain-level measures may offer a more stable target for predicting life-limiting pain.
SummaryNeuropathic pain after spinal cord injury appears early and does not always persist. A threshold-free score, unlike binary classification, tracks how pain limits daily life.
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BibTeX
@misc{gumbel2026trajectories,
title = {{Trajectories and characteristics of pain in the first year after spinal cord injury: a TRACK-SCI study}},
author = {J. H. Gumbel and E. Mendoza and M. Arellano and J. R. Huie and D. D. Hemmerle and L. U. Pascual and V. Singh and A. V. Keller and X. Bradfield and P. R. Weinstein and J. C. Bresnahan and M. S. Beattie and A. R. Ferguson and J. L. K. Kramer and N. Kyritsis and TRACK-SCI Investigators},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.21.26366160},
url = {https://www.medrxiv.org/content/10.64898/2026.10.21.26366160v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Trajectories and characteristics of pain in the first year after spinal cord injury: a TRACK-SCI study
AU - J. H. Gumbel
AU - E. Mendoza
AU - M. Arellano
AU - J. R. Huie
AU - D. D. Hemmerle
AU - L. U. Pascual
AU - V. Singh
AU - A. V. Keller
AU - X. Bradfield
AU - P. R. Weinstein
AU - J. C. Bresnahan
AU - M. S. Beattie
AU - A. R. Ferguson
AU - J. L. K. Kramer
AU - N. Kyritsis
AU - TRACK-SCI Investigators
PY - 2026
DA - 2026/10/21
PB - medRxiv
DO - 10.64898/2026.10.21.26366160
UR - https://www.medrxiv.org/content/10.64898/2026.10.21.26366160v1
AB - Chronic pain affects most individuals with spinal cord injury (SCI) and frequently impairs daily function, and nearly half experience neuropathic pain. Neuropathic pain is commonly thought to develop months after injury and to persist once established. These views rest on classifying each patient as having neuropathic pain or not, although patients often report several pains. The same binary label is the usual target of prognostic and biomarker studies that aim to predict life-limiting pain. We tracked up to three of the worst pains per interview from injury to one year in 140 TRACK-SCI participants, using the DN4 interview (DN4i, threshold 3). Within three days of injury, half of all pain areas and three quarters of participants met the threshold, and pain-area prevalence changed little over the year. Individual pains, however, often changed. Only a third remained above the threshold throughout, one third resolved or fluctuated, and pains in the same person often followed different courses. At more than half of interviews with several pains, one pain met the threshold while another did not, so that the patients classification depended on the pain considered. We therefore derived a threshold-free Pain Composite Score from the DN4i items and pain intensity. The items formed a single dimension, and the composite was associated with sleep and mood interference whereas the binary classification was not. Neuropathic pain after SCI thus appears early, does not invariably persist, and differs between a persons pains, and graded pain-level measures may offer a more stable target for predicting life-limiting pain. SummaryNeuropathic pain after spinal cord injury appears early and does not always persist. A threshold-free score, unlike binary classification, tracks how pain limits daily life.
ER -