JOURNAL OF NEUROTRAUMA Volume 21, Number 10, 2004 © Mary Ann Liebert, Inc. Pp. 1384–1395 Exacerbation of Chronic Pain following Spinal Cord Injury EVA G. WIDERSTRÖM-NOGA 1,2,3 and DENNIS C. TURK 4 ABSTRACT Because of the high prevalence and the refractory nature of pain following spinal cord injury (SCI), it is important to increase the understanding of what factors aggravate different types of pain. This information is related to pain generating mechanisms and may thus be useful in the diagnosis and management of these difficult pain conditions. The aims of the present study were to (1) identify variables (factors) that exacerbate chronic pain associated with SCI and (2) define the relationships among these patterns of pain exacerbation, specific pain characteristics, and psychological features. A sample out of 159 (75.5%) people with SCI and chronic pain, volunteered to participate in a mail survey. Over 50% of the sample indicated that prolonged sitting, infections, fatigue, muscle spasms, cold weather, and sudden movements exacerbated their pain. A principal components analysis de- tected five sets of factors that were reported to magnify pain: negative mood, prolonged afferent ac- tivity (bowel, bladder, somatic), weather, voluntary physical activity, and transient somatic afferent ac- tivity. Negative mood and prolonged afferent activity were frequently and significantly associated with both pain characteristics and psychosocial issues. A multiple regression analysis revealed that a combination of decreased activity levels due to pain (t  3.54; p  0.001), pain located in the frontal aspects of torso (including genitals) (t  2.29; p  0.05), “burning” (t  2.26; p  0.05), or “electric” (t  2.09; p  0.05) pain, and a limited perception of life control (t  -2.16; p  0.05) was signifi- cantly associated with a high extent of pain aggravation (R 2  0.39; p  0.000). Key words: allodynia; exacerbation; hyperalgesia; Multidimensional Pain Inventory; neuropathic pain; SCI; visceral pain 1384 1 The Miami Project to Cure Paralysis, 2 Department of Neurological Surgery, University of Miami, Miami, Florida. 3 VAMC, Miami, Florida. 4 Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington. INTRODUCTION O NE OF THE NEUROBIOLOGICAL SEQUELAE of spinal cord injury (SCI) is persistent pain that significantly diminishes quality of life (Levi et al., 1995; Anson and Shepherd, 1996; Westgren and Levi, 1998) and interferes with routine daily activities and physical functioning, in- cluding sleep (Dalyan et al., 1999; Ravenscroft et al., 2000; Widerström-Noga et al., 2001a). The majority of people simultaneously experience dif- ferent types of pain following a SCI (Rintala et al., 1998; Turner et al., 2001; Widerström-Noga et al., 2001b). It is reasonable to expect that different pain mechanisms may be involved in the generation of different types of pain.