Chronic pain and its impact on quality of life following a traumatic rib fracture

Shelat, Vishal G; Eileen, S.; John, Lauri D.; Teo, Li Tserng; Appasamy, Vijayan; Chiu, MT

doi:10.1007/s00068-012-0186-x

Cited by 45 publications

(36 citation statements)

References 13 publications

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“…One small retrospective investigation of rib fracture patients in a trauma registry (102 patients) found no specific risk factors of chronic pain beyond 12 months. However, the differences from our results could be explained by study population dissimilarities (the majority of patients in the trauma registry study had other concomitant injuries; those patients were excluded from our cohort to isolate the effect of MTI), by its small sample size, and by its retrospective study design (no systematic evaluation or follow‐up) . Another small study (80 patients) focused on pain as a secondary outcome (the primary outcome was to compare the analgesic effect of tramadol to nonsteroidal anti‐inflammatory drugs) .…”

Section: Discussionmentioning

confidence: 78%

“…Up to 90% of MTI patients will seek medical attention within 72 hours of trauma . MTI can produce significant pain that can last for several months . This thoracic pain, often severe at the time of the trauma, can significantly limit the ability to work and to perform daily activities.…”

mentioning

confidence: 99%

“…Chronic pain syndrome is defined as pain without apparent biologic duration or “appropriateness” (most studies use a 3‐month duration) . Up to 22.5% of rib fracture patients report chronic pain, affecting lifestyle or work in 48%, with 26% requiring analgesics on a regular basis . To date, we are aware of no studies that have discerned risk factors of significant pain 90 days after MTI, and detecting them may help in planning ED discharge‐specific treatment strategies.…”

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confidence: 99%

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Risk Factors of Significant Pain Syndrome 90 Days After Minor Thoracic Injury: Trajectory Analysis

et al. 2013

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Objectives: The objective was to identify the risk factors of clinically significant pain at 90 days in patients with minor thoracic injury (MTI) discharged from the emergency department (ED).Methods: A prospective, multicenter, cohort study was conducted in four Canadian EDs from November 2006 to November 2010. All consecutive patients aged 16 years or older with MTI were eligible at discharge from EDs. They underwent standardized clinical and radiologic evaluations at 1 and 2 weeks, followed by standardized telephone interviews at 30 and 90 days. A pain trajectory model characterized groups of patients with different pain evolutions and ascertained specific risk factors in each group through multivariate analysis.Results: In this cohort of 1,132 patients, 734 were eligible for study inclusion. The authors identified a pain trajectory that characterized 18.2% of the study population experiencing clinically significant pain (>3 of 10) at 90 days after a MTI. Multivariate modeling found two or more rib fractures, smoking, and initial oxygen saturation below 95% to be predictors of this group of patients. Conclusions:To the authors' knowledge, this is the first prospective study of trajectory modeling to detect risk factors associated with significant pain at 90 days after MTI. These factors may help in planning specific treatment strategies and should be validated in another prospective cohort.ACADEMIC EMERGENCY MEDICINE 2013; 20:1139-1145 © 2013 by the Society for Academic Emergency Medicine M inor thoracic injuries (MTI) represent up to 42% of emergency department (ED) visits for blunt chest trauma, and they are mainly caused by falls of less than 2 meters and motor vehicle accidents. 1,2 Up to 90% of MTI patients will seek medical attention within 72 hours of trauma. 3 MTI can produce significant pain that can last for several months. 4 This thoracic pain, often severe at the time of the trauma, 5 can significantly limit the ability to work and to perform daily activities. It has been suggested that MTI-related pain also hinders the ability to cough and breathe deeply, which can lead to atelectasis, accumulation of secretions, hypoxia, and infection. 6,7 Although a low incidence (<1%) of delayed pneumonia in nonhospitalized MTI patients was demonstrated in a recent study, 8 some patients will have clinically or radiologically confirmed rib fractures. It was shown that standardized chest radiographs can miss up to 50% of the rib fractures detected clinically, by tomography or by ultrasound. [9][10][11][12][13] Bergeron et al. 7 suggested that elderly patients hospitalized with rib fractures after blunt thoracic trauma are at increased risk of mortality. Another study showed that MTI in this population is also associated with a significant rate of complications (36%)

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Section: Discussionmentioning

confidence: 78%

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confidence: 99%

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confidence: 99%

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Risk Factors of Significant Pain Syndrome 90 Days After Minor Thoracic Injury: Trajectory Analysis

et al. 2013

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“…Pain may cause strong distressing sensation whereas local discomfort meant as an unpleasant or abnormal sensitivity to touch by CPT. There are studies reported that all trauma patients with acute pain upon discharge should receive a routine practice of prescribed analgesic, which may cause poor restricted movement, and inability to breath and participate in normal activities [39,40,41]. In the current study, all patients who were encouraged to carry out physiotherapy practice up to 6 months, they were taking the prescribed oral analgesics post discharge and immediate pre CPT.…”

Section: Discussionmentioning

confidence: 88%

The Impact of Chest Physiotherapy Technique (CPT) on Respiration, Pain and Quality of Life Post Thoracic Wall Fixation Surgery among Flail Chest Patients (FC)

Mohamed¹,

Ragab²,

Abdel-Bary³

et al. 2018

AJNR

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Background: FC is the most extreme type of blunt chest wall casualty with death rate up to 20%. These patients may require prolonged days of mechanical ventilation for ongoing respiratory dysfunction, leading to high rates of pulmonary complications. This study aimed to assess the impact of CPT on respiration, pain and quality of life post thoracic wall fixation surgery in Flail Chest Patients. It followed a quasi-experimental, pretest-posttest comparison. The study was carried out in cardiothoracic surgery intensive care unit (ICU) at Qena university hospital. A convenience sample comprised of 30 adult patients from both sexes with flail chest and no contusion. They were given pharmacological epidural and oral analgesic medications to reduce pain during physiotherapy practice post chest stabilization surgery. Tool 1: A self-reporting Assessment Questionnaire were comprised pain rating index scores pre and post CPT and prior epidural analgesic administration, and symptoms associated with pain, Health-related quality of life and Dyspnea scale. Sociodemographic characteristics were attached to the tool 1. Tool 2: A clinical data base assessment were taken pre and post CPT, included: Part I: Laboratory investigation of a Standardized lung function tests which Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1) and Peak Expiratory Flow (PEF) were recorded and ABGs includes PaO2, PaCo2, SO2, and PH in addition to vital signs (Part II) and Diagnostic test assessment includes Chest x-ray, and chest tomography CT was done before chest stabilization surgery to confirm the diagnosis in accordance of study criteria(Part III). Tool 3: CPT include, breathing and coughing exercise and IPPB., secretion mobilization techniques like chest wall percussion, and vibration and incentive spirometer. Results/conclusion: the majority of the studied sample was male and were from 50-60 years and illiterate. The effect of CPT on the symptoms associated pain, and pain intensity were still persistent in decrease post discharge at late follow up till 6 th month. The majority of subjects had no dyspnea on 3 rd and 6 th month of follow up. so, their HRQOL scores improved with a high significance in the area of mobility, self-care, anxiety and depression, the performance of usual activities and pain and discomfort on 6 months of late follow-up. Also, it was noticed that the mean of Pulmonary Function Test (PFT), and ABGs improved in the late follow-up. This improvement has been definitively shown in all outcomes parameter post chest physiotherapy performed after surgical fixation of FC. Recommendation: Moreover, this study recommended that all the physiotherapy approaches should be planned and applied as an individual programs tailored to the FC patients following a comprehensive evaluation.

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“…However, much lower prevalence has also been reported in the literature. According to Gordy et al [32], the prevalence of CP assessed by the McGill Pain Questionnaire at 6 months of trauma was 22%. It was 22.5% in a Singapore study enrolling 102 patients with rib fractures [33].…”

Section: Discussionmentioning

confidence: 99%

Chronic Pain following Chest Trauma: Prevalence, Associated Factors, and Psychosocial Impact

Kahloul

Kacem

Sboui

et al. 2020

Pain Research and Management

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Background. Chronic pain (CP) is a real public health concern. It is a common cause of poor quality of life and workplace absenteeism. It is well studied in many medical and surgical fields. However, only few data are available as regards to its occurrence in trauma patients. Purpose. To assess the prevalence, associated factors, and psychosocial impact of CP following chest trauma. Methods. This is an observational, descriptive, and analytic cross-sectional study performed in a Tunisian department of anesthesia and intensive care over a two-month period. Adult patients admitted one year ago for isolated chest trauma were enrolled. Data were collected by a phone interview. Studied variables were sociodemographic characteristics, traumatic injuries and their management, the occurrence of CP, and its psychosocial impact. CP was diagnosed by the Brief Pain Inventory (BPI) considering an evolution period of at least 3 months. Its impact was assessed by the BPI and the Posttraumatic stress disorder Checklist Scale (PCLS). Results. Fifty-four patients were included in the study. The prevalence of CP was 79.6%. The average CP intensity was 3.18 ± 1.4. It was neuropathic in 90.7%. Its main associated factors were pleural effusion (p=0.016), time to ICU admission (p=0.05), and posttraumatic stress disorders (p=0.017). After a multivaried analysis, only pleural effusion was associated with CP (p=0.01, OR = 6.9 CI 95% [1.2–37.3]). Probable or very likely PTSDs were noted, respectively, in 10 and 9 cases. Regarding the psychosocial impact of CP, the most commonly affected dimensions were general activity, work, sleep, and mood. Conclusion. CP following chest trauma is frequent and severe requiring preventive measures such as high risk patients screening, better management of acute pain, and a multidisciplinary approach for patients with diagnosed CP.

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Chronic pain and its impact on quality of life following a traumatic rib fracture

Abstract: This study confirms the high incidence of chronic pain after a traumatic rib fracture. While the majority of the patients can manage this pain without interference of their quality of life, a few do suffer from life style/work interference and may have to resort to regular analgesic usage.

Cited by 45 publications

References 13 publications

Risk Factors of Significant Pain Syndrome 90 Days After Minor Thoracic Injury: Trajectory Analysis

Risk Factors of Significant Pain Syndrome 90 Days After Minor Thoracic Injury: Trajectory Analysis

The Impact of Chest Physiotherapy Technique (CPT) on Respiration, Pain and Quality of Life Post Thoracic Wall Fixation Surgery among Flail Chest Patients (FC)

Chronic Pain following Chest Trauma: Prevalence, Associated Factors, and Psychosocial Impact

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