Background: Individuals with spinal cord injury (SCI) have a more than twofold increased risk of heart disease and stroke compared with able-bodied individuals. The increased risk appears to be in excess of the risk conferred by several well-established risk factors, including diabetes, hypertension, and sex. This raises the question whether other factors, secondary to SCI, are also contributing to the development of cardiovascular disease (CVD). Two potential factors associated with SCI and CVD are pain and depression. Both are frequently reported among individuals with SCI, develop in the acute stages of injury, and are commonly described as severe. Therefore, the primary aim of this study was to examine the relationship between pain (and types of pain) and depression with CVD among individuals with SCI. Methods: A total of 1,493 individuals (referred sample) with chronic SCI participated in a self-report cross-sectional multicenter Canada-wide survey from 2011-2012 (mean age ± standard deviation: 49.6 ± 13.9 years). Results: After adjustment for age, sex, and injury characteristics, neuropathic pain and depression were significantly and independently associated with CVD (adjusted odds ratio and 95% confidence interval: 2.27 (1.21, 4.60) for neuropathic pain; 4.07 (2.10, 7.87) for depression). In contrast to neuropathic pain, non-neuropathic pain was not significantly associated with CVD (p = 0.13). Conclusion: In conclusion, these data illustrate important interrelationships between secondary complications following SCI, as well as raise the possibility of neuropathic pain (versus nociceptive pain) as a novel and emerging risk factor for CVD.

Cragg JJ, Noonan VK, Krassioukov A, Borisoff J: Cardiovascular disease and spinal cord injury: results from a national population health survey. Neurology 2013;81:723-728.
Wu JC, Chen YC, Liu L, Chen TJ, Huang WC, Cheng H, Tung-Ping S: Increased risk of stroke after spinal cord injury: a nationwide 4-year follow-up cohort study. Neurology 2012;78:1051-1057.
Wahman K, Nash MS, Lewis JE, Seiger A, Levi R: Cardiovascular disease risk and the need for prevention after paraplegia determined by conventional multifactorial risk models: the Stockholm spinal cord injury study. J Rehabil Med 2011;43:237-242.
Groah SL, Nash MS, Ward EA, Libin A, Mendez AJ, Burns P, Elrod M, Hamm LF: Cardiometabolic risk in community-dwelling persons with chronic spinal cord injury. J Cardiopulm Rehabil Prev 2011;31:73-80.
Chen YK, Hung TJ, Lin CC, Yen RF, Sung FC, Lee WY, Kao CH: Increased risk of acute coronary syndrome after spinal cord injury: a nationwide 10-year follow-up cohort study. Int J Cardiol 2013;168:1681-1682.
Cragg JJ, Stone JA, Krassioukov AV: Management of cardiovascular disease risk factors in individuals with chronic spinal cord injury: an evidence-based review. J Neurotrauma 2012;29:1999-2012.
Siddall PJ, McClelland JM, Rutkowski SB, Cousins MJ: A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain 2003;103:249-257.
Finnerup NB, Baastrup C: Spinal cord injury pain: mechanisms and management. Curr Pain Headache Rep 2012;16:207-216.
McBeth J, Symmons DP, Silman AJ, Allison T, Webb R, Brammah T, Macfarlane GJ: Musculoskeletal pain is associated with a long-term increased risk of cancer and cardiovascular-related mortality. Rheumatology (Oxford) 2009;48:74-77.
Musselman DL, Nemeroff CB: Depression really does hurt your heart: stress, depression, and cardiovascular disease. Prog Brain Res 2000;122:43-59.
Nemeroff CB, Musselman DL: Are platelets the link between depression and ischemic heart disease? Am Heart J 2000;140(4 suppl):57-62.
Van der Kooy K, van Hout H, Marwijk H, Marten H, Stehouwer C, Beekman A: Depression and the risk for cardiovascular diseases: systematic review and meta analysis. Int J Geriatr Psychiatry 2007;22:613-626.
Handberg EM, Eastwood JA, Eteiba W, Johnson BD, Krantz DS, Thompson DV, Vaccarino V, Bittner V, Sopko G, Pepine CJ, Merz NB, Rutledge TR: Clinical implications of the women's ischemia syndrome evaluation: inter-relationships between symptoms, psychosocial factors and cardiovascular outcomes. Womens Health (Lond Engl) 2013;9:479-490.
Haythornthwaite JA, Benrud-Larson LM: Psychological aspects of neuropathic pain. Clin J Pain 2000;16:S101-S105.
Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J: Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008;70:1630-1635.
Solaro C, Brichetto G, Amato MP, Cocco E, Colombo B, D'Aleo G, Gasperini C, Ghezzi A, Martinelli V, Milanese C, Patti F, Trojano M, Verdun E, Mancardi GL; PaIMS Study Group: The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study. Neurology 2004;63:919-921.
Kannel WB, McGee DL: Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study. Diabetes Care 1979;2:120-126.
Gordis L: Epidemiology, ed 4. Philadelphia, Saunders, 2009.
Engstad T, Bonaa KH, Viitanen M: Validity of self-reported stroke: the Tromso study. Stroke 2000;31:1602-1607.
Bergmann MM, Byers T, Freedman DS, Mokdad A: Validity of self-reported diagnoses leading to hospitalization: a comparison of self-reports with hospital records in a prospective study of American adults. Am J Epidemiol 1998;147:969-977.
Finnerup NB, Johannesen IL, Sindrup SH, Bach FW, Jensen TS: Pain and dysesthesia in patients with spinal cord injury: a postal survey. Spinal Cord 2001;39:256-262.
West CR, Mills P, Krassioukov AV: Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: a meta-analysis. Spinal Cord 2012;50:484-492.
Zhu C, Galea M, Livote E, Signor D, Wecht JM: A retrospective chart review of heart rate and blood pressure abnormalities in veterans with spinal cord injury. J Spinal Cord Med 2013;36:463-475.
Wecht JM, Zhu C, Weir JP, Yen C, Renzi C, Galea M: A prospective report on the prevalence of heart rate and blood pressure abnormalities in veterans with spinal cord injuries. J Spinal Cord Med 2013;36:454-462.
Anson CA, Shepherd C: Incidence of secondary complications in spinal cord injury. Int J Rehabil Res 1996;19:55-66.
Noreau L, Proulx P, Gagnon L, Drolet M, Laramee MT: Secondary impairments after spinal cord injury: a population-based study. Am J Phys Med Rehabil 2000;79:526-535.
McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ: Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil 1999;80:1402-1410.
Jadidi E, Mohammadi M, Moradi T: High risk of cardiovascular diseases after diagnosis of multiple sclerosis. Mult Scler 2013;19:1336-1340.
Redfors B, Shao Y, Omerovic E: Stress-induced cardiomyopathy in a patient with chronic spinal cord transection at the level of C5: endocrinologically mediated catecholamine toxicity. Int J Cardiol 2012;159:e61-e62.
De Smedt RH, Jaarsma T, van den Broek SA, Haaijer-Ruskamp FM: Decompensation of chronic heart failure associated with pregabalin in a 73-year-old patient with postherpetic neuralgia: a case report. Br J Clin Pharmacol 2008;66:327-328.
Erdogan G, Ceyhan D, Gulec S: Possible heart failure associated with pregabalin use: case report. Agri 2011;23:80-83.
Murphy N, Mockler M, Ryder M, Ledwidge M, McDonald K: Decompensation of chronic heart failure associated with pregabalin in patients with neuropathic pain. J Card Fail 2007;13:227-229.
Page RL 2nd, Cantu M, Lindenfeld J, Hergott LJ, Lowes BD: Possible heart failure exacerbation associated with pregabalin: case discussion and literature review. J Cardiovasc Med (Hagerstown) 2008;9:922-925.
Hippisley-Cox J, Pringle M, Hammersley V, Crown N, Wynn A, Meal A, Coupland C: Antidepressants as risk factor for ischaemic heart disease: case-control study in primary care. BMJ 2001;323:666-669.
Jouanjus E, Lapeyre-Mestre M, Micallef J; The French Association of the Regional Abuse and Dependence Monitoring Centres (CEIP-A) Working Group on Cannabis Complications: Cannabis use: signal of increasing risk of serious cardiovascular disorders. J Am Heart Assoc 2014;3:e000638.
Ohlin B, Nilsson PM, Nilsson JA, Berglund G: Chronic psychosocial stress predicts long-term cardiovascular morbidity and mortality in middle-aged men. Eur Heart J 2004;25:867-873.
Tsigos C, Chrousos GP: Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res 2002;53:865-871.
Sleight P: Smoking and hypertension. Clin Exp Hypertens 1993;15:1181-1192.
Leong KS, Wilding JP: Obesity and diabetes. Baillieres Best Pract Res Clin Endocrinol Metab 1999;13:221-237.
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