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Chronic Pain Secondary to Disability: A Review

Ehde, Dawn M. Ph.D.*; Jensen, Mark P. Ph.D.*†; Engel, Joyce M. Ph.D., OTR/L*; Turner, Judith A. Ph.D.*‡; Hoffman, Amy J. B.S.*; Cardenas, Diana D. M.D.*

Special Topic Series: Pain in Patients With Disabilities

Background Until recently, very little has been written regarding chronic pain as a secondary problem in persons who already have a physical disability, despite the potential for pain to increase the negative impact of what may already be a very disabling condition. The purpose of this review is to summarize what is currently known concerning the nature and scope of chronic pain as a secondary condition to disability, specifically spinal cord injury, acquired amputations, cerebral palsy, multiple sclerosis, neuromuscular disease, and postpolio syndrome.

Method What is known concerning the frequency, severity, impact, and treatment of pain in these specific conditions is reviewed, as are the factors that contribute to, or are associated with, adjustment to chronic pain in these disability groups. The authors conclude with several research questions that emerge from this knowledge, the answers to which will contribute to the long-term goal of the reduction of pain and suffering in persons with disabilities.

Conclusions The existing literature clearly documents that many persons with disabilities experience chronic pain. Many questions remain unanswered regarding the scope, severity, and treatment of chronic pain in these groups.

Departments of *Rehabilitation Medicine and ‡Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, and †Multidisciplinary Pain Center, University of Washington Medical Center—Roosevelt, Seattle, Washington, U.S.A.

Received October 30, 2001;

revised March 13, 2002; accepted March 20, 2002.

Supported by grant (“Management of Chronic Pain in Rehabilitation”) PO1 HD/NS33988, from the National Institute of Child Health and Human Development and the National Institute of Neurologic Disorders and Stroke; and by grant #H133B980017 from the Department of Education's National Institute of Disability and Rehabilitation Research.

Address correspondence and reprint requests to Dawn M. Ehde, Department of Rehabilitation Medicine, Box 359740, 325 9th Avenue, Harborview Medical Center, Seattle, WA 98104-2499, U.S.A.; e-mail:

© 2003 Lippincott Williams & Wilkins, Inc.