Clinical Significance of Pain at Hospital Discharge Following Traumatic Orthopedic Injury

Archer, Kristin R.; Heins, Sara E.; Abraham, Christine M.; Obremskey, William T.; Wegener, Stephen T.; Castillo, Renan C.

doi:10.1097/ajp.0000000000000246

Cited by 56 publications

(43 citation statements)

References 54 publications

(70 reference statements)

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“…We found that 65% of the patients reported severe pain (mean NRS 6) shortly after ICU discharge. This is similar to a follow‐up study in orthopaedic patients reporting an average pain intensity (BPI of 6.3 [SD 2.4]), with 44% of the patients having severe pain in the past 24 hours (NRS ≥ 7) before hospital discharge. Furthermore, a higher pain interference score in the ward was associated with a higher PTSS‐10 score.…”

Section: Discussionsupporting

confidence: 85%

“…Furthermore, a higher pain interference score in the ward was associated with a higher PTSS‐10 score. Archer et al found, in orthopaedic patients, using the Clinical‐Administered PTSD Scale and Mississippi PTSD Scale significant correlations between pain and PTSD at hospital discharge and after 1 year. To the best of our knowledge, our study is the first to measure pain in a general ICU population in the ward shortly after ICU discharge, and the amount of patients reporting pain and the association between pain and PTS symptoms/PTSD warrant further research.…”

Section: Discussionmentioning

confidence: 99%

“…They also described that pre‐ICU psychopathology was associated with PTS symptoms . Increased pain at hospital discharge in traumatic orthopaedic patients has been shown to correlate with PTSD . In addition, it has been shown that trauma patients with PTS symptoms are at risk of “self‐medication” with alcohol and that alcohol use can reduce recovery from PTSD in female crime victims .…”

Section: Introductionmentioning

confidence: 99%

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Post‐traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge

Valsø

Rustøen

Skogstad

et al. 2019

Nursing in Critical Care

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Background Post‐traumatic stress (PTS) symptoms following intensive care unit (ICU) treatment can lead to post‐traumatic stress disorder and represent a severe health burden. In trauma patients, a strong sense of coherence (SOC) is associated with fewer PTS symptoms. However, this association has not been investigated in a general ICU sample. Aims and objectives To examine the occurrence of PTS symptoms in general ICU patients early after ICU discharge and to assess possible associations between PTS symptoms and SOC, ICU memory, pain, and demographic and clinical characteristics. Design This was a cross‐sectional study. Methods Adult patients aged ≥18 years admitted for ≥24 hours to five ICUs between 2014 and 2016 were recruited. PTS symptoms and SOC were measured at the ward within the first week after discharge from the ICU using the Posttraumatic Stress Scale‐10 and Sense of Coherence Scale‐13. Multiple linear regression analysis was used to identify associations between PTS symptoms and SOC and the selected independent variables. Results A total of 523 patients were included (17.8% trauma patients; median age 57 years [range 18‐94]; 53.3% male). The prevalence of clinically significant PTS symptoms was 32%. After adjustments for gender and age, lower SOC (P < 0.001), more ICU delusional memories (P < 0.001), greater pain interference (P < 0.001), not being a trauma patient (P = 0.02), and younger age (P = 0.03) were significantly associated with more PTS symptoms. Conclusions One third of patients experienced clinically relevant PTS symptoms early after discharge from the ICU. In the present study, SOC, delusional memory, pain interference, younger age, and not being a trauma patient were factors associated with more PTS symptoms. Relevance to clinical practice Early individual follow up after ICU discharge focusing on pain relief and delusional memory may reduce PTS symptoms, with a potential of improving rehabilitation.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Post‐traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge

Valsø

Rustøen

Skogstad

et al. 2019

Nursing in Critical Care

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“…Indeed, by definition pain comprises psychological elements (IASP, 1994), thereby suggesting that, in part, analgesia depends on them. The extant literature demonstrates that psycho-pathology is both an antecedent (Gerrits, van Marwijk, van Oppen, van der Horst, & Penninx, 2015) and a consequence of persistent pain (Archer et al, 2016). Extending the scope beyond formal psychopathology, psychological factors that are known to influence pain and analgesia include cognition (Burns, Glenn, Bruehl, Harden, & Lofland, 2003; Darnall et al, 2017; Salomons, Moayedi, Erpelding, & Davis, 2014; Seminowicz & Davis, 2006; Seminowicz et al, 2013; Ziadni, Sturgeon, et al, 2018), emotion (Burns et al, 2015; McCracken & Keogh, 2009; Vlaeyen, Crombez, & Linton, 2016), appraisal (Ziadni, Sturgeon, et al, 2018), expectations (Atlas et al, 2012; Colloca & Miller, 2011b; Palermo & Drotar, 1996; Wager, Atlas, Leotti, & Rilling, 2011), attention (Kucyi, Salomons, & Davis, 2013; Seminowicz & Davis, 2006), beliefs about pain and its treatment (Carriere, Martel, Kao, Sullivan, & Darnall, 2017; Carriere et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Optimizing Placebo and Minimizing Nocebo to Reduce Pain, Catastrophizing, and Opioid Use: A Review of the Science and an Evidence-Informed Clinical Toolkit

Darnall

Colloca

2018

International Review of Neurobiology

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Pain, a noxious psychosensory experience, motivates escape behavior to assure protection and survival. Psychological factors alter the experience and trajectory of pain, as well as behavior and treatment response. In the context of pain, the placebo effect (expectation for pain relief) releases endogenous opioids and facilitates analgesia from exogenously administered opioids. Nocebo hyperalgesia (expectation for persistent or worsening pain) opposes endogenous opioid analgesia and patient engagement in prescription opioid tapering. Reductions in nocebo hyperalgesia and pain catastrophizing may enhance descending modulation of pain, mediate adaptive structural brain changes and promote patient engagement in opioid tapering. Interventions that minimize nocebo and optimize placebo may adaptively shape the central nervous system toward pain relief and potentially opioid reduction. Here we provide a critical description of catastrophizing and its impact on pain, placebo and nocebo effects. We also consider the importance of minimizing nocebo and optimizing placebo effects during prescription opioid tapering, and offer a clinical toolkit of resources to accomplish these goals clinically.

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“…Discharge pain scores can be identified as an outcome for discharge. There are other implications of poor pain control on discharge from the hospital identified such as long-term depression and PTSD [22]. Pain must be controlled in the hospital to prevent the development of chronic pain out of the hospital.…”

Section: Discussionmentioning

confidence: 99%

Acute Longitudinal Pain Trajectories in the Traumatically Injured

Trevino¹

2015

SOJAPM

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The purpose of this study was to determine if in-hospital pain trajectories exist and if certain pain trajectories predict the development of pain in 101 participants at four months post-trauma. The growth mixture model analysis suggested the presence of 5 latent classes, with observed and predicted trajectories. It appears that patients in classes 1 (low initial pain) and 3 (high initial pain dropping fast and staying low) tend to have less pain at 4 months, while patients in Class 5 (high initial pain dropping fast, but rebounding) tend to have more pain at 4 months. This study did not provide definitive evidence that the trajectory of in-hospital pain predicts the development of chronic pain. Unfortunately, the latent slope did not predict pain scores at four months. However, it was found that probability of developing chronic pain measured by the numeric pain score (NPS 0-3=no chronic pain, NPS 4-10=chronic pain) with a discharge NPS of 0-2 is 0.06, 2-4 is 0.29, 4-6 is 0.35, 6-8 is 0.50 and 8-10 are 0.80. Pain must be controlled in the hospital to prevent the development of chronic pain out of the hospital. Clinicians can identify those at risk by reviewing their average pain scores on the day of discharge.Perspective: This manuscript addresses the issues of pain trajectories that have been previously published in the Journal of Pain. However, this study applied the previously published ideas to the longitudinal development of chronic pain. This is a novel attempt at determining pain trajectories and their relationship to the development of chronic pain.

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Clinical Significance of Pain at Hospital Discharge Following Traumatic Orthopedic Injury

Cited by 56 publications

References 54 publications

Post‐traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge

Post‐traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge

Optimizing Placebo and Minimizing Nocebo to Reduce Pain, Catastrophizing, and Opioid Use: A Review of the Science and an Evidence-Informed Clinical Toolkit

Acute Longitudinal Pain Trajectories in the Traumatically Injured

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