title: Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Pain following spinal cord injury Postsurgical pain outcome assessment Spinal cord injury: a search for determinants of depression two years after the event. The visual analogue pain intensity scale: what is moderate pain in millimetres? Non-painful sensory phenomena after spinal cord injury
abstract: Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design Some patients with spinal cord injury ( SCI ) complain of severe pain . The purpose of this study was to investigate the prevalence and classification of SCI-related pain , in terms of severity , location , aggravating and alleviating factors . 47 SCI individuals were studied between 15 and 67 years of age . Sixty-one percent of subjects experienced pain of moderate to severe intensity . 32 subjects complained of pain in the lower limbs , five patients had pain in the visceral region , eight in the pelvic and perineal areas . The pain duration was for a median of 5 weeks . The patients with pain were older ( median 41 years ) than those without pain ( median 23 years ) .  Pain was reported to be more intense in the evening and at night . The incidence of pain was higher in patients with thoracolumbar and incomplete spinal cord lesions .  Inactivity , stress , weather change , overactivity were identified as aggravating factors . Sleep and rest were demonstrated as alleviating factors & NA ; Reliable and valid measures of pain are essential for conducting clinical trials of pain treatments . Perhaps the most important aspect of a pain measure 's validity is its sensitivity , or ability to detect changes in pain over time and due to treatment . Several factors may affect a measure 's sensitivity , including the complexity of the rating task for the measure , the number of pain intensity levels assessed by the measure , the dimension of pain assessed ( e.g. pain intensity vs. pain relief ) , and the number of individual ratings ( e.g. single rating vs. composite score ) used to create the measure . The purpose of this study was to compare the relative sensitivity of three measures of outcome and a composite made up of all three measures for detecting analgesic effects in two sample s of persons participating in a r and omized controlled trial . One hundred and twenty‐three patients who had undergone knee surgery and 124 women who had undergone a laparotomy were given one of three medications in the day after their surgery : morphine , ketorolac , or placebo . Two measures of pain intensity ( a visual analog scale ( VAS ) and a 4‐point verbal rating scale ( VRS ) ) were administered at baseline , and these measures plus a 5‐point VRS of pain relief were administered at 16 additional time points up to 24 h following surgery . As predicted , we found variability in the sensitivity of the outcome measures used in these studies , with the 4‐point VRS showing less sensitivity than the VAS or relief ratings . However , contrary to our prediction , a composite measure of outcome made up of all three measures was not consistently superior to the individual measures for detecting treatment effects . Finally , we found that pain relief ratings were related to , but also distinct from , change in pain intensity as measured by changes in pain intensity ratings from baseline to each postmedication assessment point . These findings have important implication s for the assessment of pain in clinical trials A prospect i ve longitudinal study employing repeated measures was used to isolate factors which might predispose a person to depression two years after sustaining spinal cord injury ( SCI ) . Thirty-one subjects who suffered acute spinal injuries result ing in permanent loss of movement , and who had no head injuries or any pre-existing psychopathology , were at least 17 years of age , and who were able to speak English , participated in the study . Using the Beck Depression Inventory ( BDI ) as a measure of depression , a regression analysis demonstrated that the experience of pain two years post-injury and feeling out of control of one 's life prior to hospital discharge were predictive of depression two years post-injury . No demographic variables or injury characteristics such as level of lesion or completeness of lesion were related to long-term depression .  Pain management and rehabilitation techniques that enhance the individual 's belief of control over their lives are therefore recommended as interventions that could act to reduce depression in the long term in persons with spinal cord injury Abstract One way to ensure adequate sensitivity for analgesic trials is to test the intervention on patients who have established pain of moderate to severe intensity . The usual criterion is at least moderate pain on a categorical pain intensity scale . When visual analogue scales ( VAS ) are the only pain measure in trials we need to know what point on a VAS represents moderate pain , so that these trials can be included in meta‐ analysis when baseline pain of at least moderate intensity is an inclusion criterion . To investigate this we used individual patient data from 1080 patients from r and omised controlled trials of various analgesics .  Baseline pain was measured using a 4‐point categorical pain intensity scale and a pain intensity VAS under identical conditions . The distribution of the VAS scores was examined for 736 patients reporting moderate pain and for 344 reporting severe pain .  The VAS scores corresponding to moderate or severe pain were also examined by gender . Baseline VAS scores recorded by patients reporting moderate pain were significantly different from those of patients reporting severe pain . Of the patients reporting moderate pain 85 % scored over 30 mm on the corresponding VAS , with a mean score of 49 mm . For those reporting severe pain 85 % scored over 54 mm with a mean score of 75 mm . There was no difference between the corresponding VAS scores of men and women . Our results indicate that if a patient records a baseline VAS score in excess of 30 mm they would probably have recorded at least moderate pain on a 4‐point categorical scale OBJECTIVES Non-painful sensory phenomena or “ phantom ” sensations are common after spinal cord injury . However , the physiological mechanisms responsible for these sensations are poorly understood . The aim of this study , therefore , was to document in a prospect i ve fashion the time course , prevalence , and features of non-painful sensory phenomena after spinal cord injury , and to determine whether there was a relation between the presence of these sensations and completeness , level of injury , and type of spinal cord injury . METHODS Patients admitted to an acute spinal injuries unit were interviewed after admission and at several time points over a 2 year period to determine the presence and characteristics of non-painful sensations . Sensations were divided into simple and complex , with complex referring to sensations that incorporated a sensation of volume , length , posture , or movement . RESULTS The present study showed that the large majority ( 90 % ) of patients experience either type of sensation and most complex sensations ( 60 % ) are first experienced within 24 hours after the injury . Complex sensations were more common in those patients who had complete spinal cord injuries . The presence of either type of sensation did not seem to be related to the level of injury or the type of injury ( cord syndrome ) . A relatively small proportion ( 22 % ) of patients reported that the postural sensations were related to their position at the time of injury and sensations were more commonly related to a familiar , comfortable , or often used position before the spinal cord injury . CONCLUSION Complex sensations such as postural illusions seem to be due to functional changes in the CNS that may occur almost immediately after spinal cord injury . These sensations may be related to a strong sensory memory “ imprint ” that has been established before injury
target: The reported rate did not appear to be related to study quality .
  Pain prevalence in the combined sample s did not appreciably differ between males and females , those with complete versus incomplete SCI , and those with paraplegia versus tetraplegia .
  We conclude that too much heterogeneity was present in the reports to calculate a post-SCI pain prevalence rate using meta-analytic methods .
background: Published studies have reported widely divergent estimates of the prevalence of chronic pain among individuals with ( traumatic ) spinal cord injury ( SCI ) .