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 of n= 241 was formed from patients identified within 4 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 ANOVA approaches identified distinct trajectories of recovery within pain interference and pain severity data. Results For pain interference, the 3 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 2 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 3 meaningful recovery trajectories can be identified in an international, mixed-injury sample when pain interference is the outcome, and 2 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.

Exploring Social Determinants of Posttraumatic Pain, Distress, Depression, and Recovery Through Cross-Sectional, Longitudinal, and Nonlinear Trends

“…The 3-trajectory model of recovery continues to be consistent in the field 17,42. We have previously used a larger dataset to derive 3 trajectories of recovery using the BPI Interference scores,17 and the SRI trajectories found here closely mirror those.…”

“…Data for this study were drawn from the demographic, social, and clinical data available in the Systematic Merging of Biology, Mental Health, and Environment (SYMBIOME, clinicaltrials.gov ID NCT02711085) prospective database. The methods of data collection have been described previously 17. Briefly, adults (aged 18 to 70) presenting to a hospital urgent care center in a midsized Canadian city for acute medical care following noncatastrophic MSK injury within the prior 3 weeks were eligible.…”

“…Comprising 9 items drawn verbatim from the diagnostic criteria of the Diagnostics and Statistics Manual IV-revised version,24 the tool can be used as either an indicator of “depressive symptoms” or a likelihood estimate for the presence of diagnosable depressive disorder 23,25. For purposes of this study the former was used, retaining the score in a continuous form as a rating of depressive symptom severity. Outcome for analysis 2: predicting 12-month health-related satisfaction trajectory through preinjury characteristics The Satisfaction and Recovery Index (SRI): We have previously identified recovery trajectories for pain severity and interference outcomes using the BPI 17. For a novel contribution to the evidence, we selected the SRI for the current analysis.…”

“…The Satisfaction and Recovery Index (SRI): We have previously identified recovery trajectories for pain severity and interference outcomes using the BPI 17. For a novel contribution to the evidence, we selected the SRI for the current analysis.…”

Effects of childhood trauma on pain‐related distress in adults

“…Data for this analysis were drawn from the prospective acute trauma SYMBIOME (Systematic Merging of Biology, Mental Health and Environment) longitudinal cohort study (clinicaltrials.gov registration number NCT02711085) for which detailed methods have been described elsewhere. (Lee et al., 2020) In brief, all consecutive patients 18 years or over presenting to the Urgent Care Centre (UCC) of a local hospital were potentially eligible if they were seeking care for symptoms related to a MSK injury that happened within the prior 3 weeks. Participants also needed to be proficient in conversational English, able to follow multistep directions and free of significant systemic comorbidities that would affect physiological reactions to trauma or likelihood of recovery such as cancer, neuromuscular disorders (e.g.…”