Spending nights away from home and pain in people with spinal cord injury: evidence from a bidirectional longitudinal analysis

Abstract Study design Retrospective longitudinal cohort study using lagged mixed-effects models. Objective To examine the bidirectional longitudinal association between spending nights away from home and pain severity among individuals with spinal cord injury (SCI). Setting National Spinal Cord Injury Model Systems (SCIMS) database in the United States. Methods Adults with traumatic SCI who contributed at least two consecutive follow-up assessments between postinjury years 1 and 45 were included ( N = 11,631; 32,027 observations). Pain severity (0–10 numeric rating scale) and spending nights away from home (0, 1–2, 3–4, or ≥ 5 nights in the prior year) were assessed at each wave. Bidirectional lagged mixed-effects models examined temporal associations while controlling for sociodemographic and injury-related covariates. Sensitivity analyses used a dichotomized participation variable and additionally adjusted for self-reported health status. Results Greater spending nights away from home at the prior wave significantly predicted lower pain severity at the subsequent wave. Conversely, higher prior pain severity significantly predicted fewer subsequent nights away from home. Sensitivity analyses using a dichotomized participation variable yielded directionally consistent findings. After adjustment for self-reported health status, the association between prior nights away from home and subsequent pain was attenuated and no longer statistically significant, suggesting broader health-related pathways may explain the relationship. Conclusions Pain and spending nights away from home were bidirectionally associated over time among individuals with SCI. These findings highlight the potential importance of leisure-oriented participation behaviors in SCI rehabilitation and support further research on health pathways linking leisure-oriented participation and pain outcomes.