The prevalence and association of neck (coat-hanger) pain and orthostatic (postural) hypotension in human spinal cord injury

Objective: To investigate the prevalence of orthostatic (postural) hypotension (OH) and neck pain in a 'coat-hanger' occipito-cervical distribution in subjects with spinal cord injury (SCI), and their association. Method: Blood pressure was measured during head-up tilt to 60degrees (to determine OH) and neck pain was assessed in 28 subjects with SCI (cervical, thoracic and lumbar level) with McGill Pain Questionnaire, visual analogue scale for pain intensity and Orthostatic Intolerance Symptoms Questionnaire for pain frequency. Results: Neck pain was reported by 53.6% of subjects. Orthostatic hypotension was present in 57.1% of subjects. Neck pain was reported by 75% of subjects with OH and 25% of subjects without OH (P<0.03, Chi-square). Features of such pain included positive correlation to upright posture and exercise, and relief when lying flat. Conclusion: There is a high prevalence of neck pain and OH in SCI, with a positive association similar to that reported in primary autonomic failure with OH. Sponsorship: International Spinal Research Trust.