Rachel Müller , Gunther Landmann, Markus Béchir, Timo Hinrichs, Ursina Arnet, Xavier Jordan , Martin W.G. Brinkhof
Empowerment, Participation & Social Integration Unit, Swiss Paraplegic Research (SPF), 6207 Nottwil, Switzerland. E-mail: rachel.mueller@paraplegie.ch
DOI: 10.2340/16501977-2241

Objective: To test the hypotheses that: (i) pain is associated with depressive symptoms and quality of life; and (ii) participation restriction, satisfaction, and frequency mediate these relationships.
Design: Population-based, cross-sectional study.
Subjects/patients: Community-dwelling individuals with spinal cord injury (n = 1,549).
Methods: Hypotheses were tested in individuals with at least moderate chronic pain on the spinal cord injury – Secondary Conditions Scale (n = 834), applying structural equation modelling to data for spinal cord injury subgroups related to lesion severity (paraplegia, tetraplegia, complete, incomplete) and time since injury (≤ 10 vs ≥ 10 years). Model parameters included pain intensity (numerical rating scale), participation frequency, restriction, satisfaction (Utrecht Scale of Evaluation of Rehabilitation–Participation; USER-Participation), depressive symptoms (5-item Mental Health Index of the Short Form Health Survey; MHI-5), and 5 selected quality of life items (World Health Organization Quality of Life Scale; WHOQoL-BREF).
Results: Structural equation models confirmed associations of pain with depressive symptoms and quality of life, as well as the mediating role of participation restriction and low satisfaction with participation. These findings were apparent in individuals with tetraplegia or complete lesion and in those ≤ 10 years since paraplegia or incomplete injury.
Conclusion: Unrestricted or satisfactory participation was found to be a crucial resource for individuals living less than 10 years with a more severe spinal cord injury, since it represents buffering potential for the negative effects of chronic pain on mental health and quality of life.

Participation buffers the negative effect of chronic pain on mood and satisfaction with life
Chronic pain is a frequent problem in individuals with spinal cord injury and can have a negative effect on mood and satisfaction with life. We tested the role of participation frequency, perceived restrictions in participation and satisfaction with participation (e.g., work, leisure activities, going out with friends) in 834 individuals with moderate to severe chronic pain. We found unrestricted or satisfactory participation to be a crucial resource for individuals living less than 10 years with a more severe spinal cord injury (i.e., complete tetraplegia), since it represents buffering potential for the negative effects of pain on mood and satisfaction with life. Interventions strengthening the buffering role of participation, in specific a reduction of perceived participation restrictions and an increase in satisfaction with participation, should be provided early after a spinal cord injury and in particular to individuals with a severe disability in order to minimize the impact of pain on participation, and in turn on mood, to improve long-term life satisfaction.