After SCI, a person commonly experience several painful syndromes that can be classified into nociceptive and neuropathic pain,based on the three-tier taxonomie from the International Association for the study of pain (IASP, 2001). Nociceptive and neuropathic paincan be further divided into subtypes (musculoskeletal, visceral resp. at, below and above lesion) and finally, into presumed mechanisms (specific structure and pathology). These different types of pain demonstrate specific characteristics that reflect the different mechanisms that underlie each type of pain. In addition, unfortunately, only a minority of SCI patients profit from conventional pain treatment. If a patient has developed neuropathic pain, it is unlikely that the symptoms resolve on its own.

Study I:
Experience of acute pain predicts chronification of pain within the first year after traumatic spinal cord injury
This longitudinal study aims to predict the occurrence of pain at 6 and 12 months by an early interview performed at 1 month post-injury and determine the individual prevalence and course of pain and pain related factors within the first year after traumatic spinal cord injury (SCI). A structured pain interview was performed at 1, 3, 6 and 12 months after SCI. The performance of a short structured pain interview as early as one month after SCI seems able to predict the outcome in patients without pain or with neuropathic pain. This rate is less evident in musculoskeletal pain. The prevalence of pain in SCI patients is high, remains stable during the first year and is quite intense. Importantly, this early detection of different pain types is possible and might prevent the development of chronic neuropathic pain that is difficult to treat.

Study II:
Mismatch between patient-reported and objective independence after SCI: Consequences for trials
The aim of the study was to investigate the course of, and the relationship between, the objective and patient-reported level of independence within the first year after spinal cord injury (SCI). The objective independence was quantified using the Spinal Cord Independence Measure (SCIM). The patient-reported subjective independence was determined by asking the subject how their general restrictions influenced their everyday life activities. Both measures were scored between 0 (no independence) to 100 (maximal independence). The current findings are important for ongoing discussions about appropriate outcome measures for clinical trials in the field of SCI. Objective and patient-reported outcome can differ strongly and evolve differently. The SCIM cannot replace a patient-reported outcome measure, while the latter might be less favorable in a trial, as functional improvement might remain undetected. It is likely that changes in patient-reported outcomes are influenced by numerous factors in addition to those associated with functional recovery - for example, psychological factors.

Study III:
The incidence of depressive symptoms is low in acute spinal cord injury compared to other neurological disorders
The aim of the study was to reveal the incidence and time course of depressive symptoms following acute spinal cord injury (SCI) in relation to clinical outcomes and for a comparison to other neurological disorders with severe impairment. In patients with acute traumatic SCI (n=130) combined follow up assessments of neurological and functional outcomes, pain and patient-rated affective factors (i.e. mood, anxiety) were prospectively (1-3-6-12 months after injury) collected during in-rehabilitation and follow up in out-patient clinics and became related to the severity of depressive symptoms (no, mild, moderate and severe) based on the Beck Depression Inventory (BDI) scores. Depressive symptoms following acute SCI are rather low and remain stable within the first year after injury despite the severe neurological impairment and loss in independency. In comparison to other neurological disorders that also involve brain function SCI patients seem to be less challenged by depressive symptoms that constitute additional burdens to respond to the severe functional impairments.