Defining pain and interference recovery trajectories after acute non-catastrophic musculoskeletal trauma through growth mixture modeling

Abstract

Background Recovery trajectories support early identification of delayed recovery and can inform personalized management or phenotyping of risk profiles in patients. The objective of this study was to investigate the trajectories in pain severity and functional interference following non-catastrophic musculoskeletal (MSK) trauma in an international, mixed injury sample. Methods A prospective longitudinal cohort (n = 241) was formed from patients identified within four weeks of trauma, from attendance at emergency or urgent care centres located in London, ON, Canada, or Chicago, IL, USA. Pain interference was measured via the Brief Pain Inventory (London cohort) or the Neck Disability Index (Chicago cohort). Pain severity was captured in both cohorts using the numeric pain rating scale. Growth mixture modeling and RM repeated measures ANOVA approaches identified distinct trajectories of recovery within pain interference and pain severity data. Results For pain interference, the three trajectories were labeled accordingly: Class 1 = Rapid recovery (lowest intercept, full or near full recovery by 3 months, 32.0% of the sample); Class 2 = Delayed recovery (higher intercept, recovery by 12 months, 26.7% of the sample); Class 3 = Minimal or no recovery (higher intercept, persistently high interference scores at 12 months, 41.3% of the sample). For pain severity, the two trajectories were labeled: Class 1 = Rapid recovery (lower intercept, recovery by 3 months, 81.3% of the sample); and Class 2 = Minimal or no recovery (higher intercept, flat curve, 18.7% of the sample). The “Minimal or No Recovery” trajectory could be predicted by female sex and axial (vs. peripheral) region of trauma with 74.3% accuracy across the 3 classes for the % Interference outcome. For the Pain Severity outcome, only region (axial trauma, 81.3% accuracy) predicted the “Minimal or No Recovery” trajectory. Conclusions These results suggest that three meaningful recovery trajectories can be identified in an international, mixed-injury sample when pain interference is the outcome, and two recovery trajectories emerge when pain severity is the outcome. Females in the sample or people who suffered axial injuries (head, neck, or low back) were more likely to be classed in poor outcome trajectories. Trial registration National Institutes of Health - clinicaltrials.gov (NCT02711085; Retrospectively registered Mar 17, 2016).

Exploring the contributions of sex and traditionally genderized interpersonal-expressive traits to variability in post-trauma pain ratings

“…Data were drawn from a prospective observational study of recovery following acute non-catastrophic MSK injury (the ‘Systematic Merging of Biology, Mental Health and Environment’ (SYMBIOME) study, clinicaltrials.gov ID number NCT02711085). Methods of screening and recruitment have been described previously [ 39 ]. In short, eligible participants were at least 18 years or older, presented to a local urgent care centre for reasons of pain or functional interference following MSK trauma within the prior 3 weeks, did not require inpatient admission or surgery, could read and understand conversational French or English, and did not have a systemic or chronic condition that would be expected to delay recovery such as cancer, neuromuscular disorders or other significant systemic diseases.…”

Estimating Risk of Chronic Pain and Disability Following Musculoskeletal Trauma in the United Kingdom

“…Recovery of posttrauma pain can therefore be summarized as very slow and by no means certain for all, a message consistent with previous studies. 5 , 6 , 7 , 40 …”

Latent profile analysis of blood marker phenotypes and their relationships with clinical pain and interference reports in people with acute musculoskeletal trauma

“…After LPA, each participant was assigned to one of the identified classes based on relative blood marker concentration. From a previous study 12 of derivation of recovery curves, each participant was also assigned to one of three trajectory classes: rapid, delayed, or minimal recovery. Both the rapid and delayed recovery groups were grouped together as a “recovery predicted” group and proportions of the blood marker clusters were statistically compared against the “minimal or no recovery predicted” group using chi-square analysis.…”

“…Longitudinal modeling studies in both clinical (6) and population-level (7) samples have identified trajectories of pain and recovery that most commonly indicate 15-25% of participants report long-term, chronic or persistent pain and functional interference after musculoskeletal trauma seemingly regardless of the body region affected (6,(8)(9)(10)(11). In a prior study (12) we identified a 3-trajectory model of functional recovery from musculoskeletal (MSK) trauma representing trajectories of rapid recovery (32.0% of the sample), delayed recovery (26.7%), and minimal or no recovery (41.3%). To briefly summarize, these trajectories were based on disability due to pain (or "pain interference") over the course of 12 months where rapid recovery had the lowest symptoms at baseline with near or full recovery by 3 months, delayed recovery had high symptoms at baseline with full recovery by 12 months, and minimal/no recovery had high symptoms at baseline that persisted throughout the study.…”