Patient coping and expectations about recovery predict the development of chronic post-surgical pain after traumatic tibial fracture repair

Abstract

Background: The association of patient expectations about recovery with the development of chronic post-surgical pain (CPSP) is uncertain. Methods: Three hundred and fifty-nine patients enrolled in the SPRINT trial completed the Somatic Preoccupation and Coping (SPOC) questionnaire six weeks after a traumatic tibial fracture repair. The SPOC questionnaire measures patients' somatic complaints, coping, and optimism for recovery. Using adjusted models, we explored the association of SPOC scores with ≥ mild CPSP and ≥ moderate pain interference with activity at one yr after surgery. Results: Of 267 tibial fracture patients with data available for analysis, 147 (55.1%) reported CPSP at one yr. The incidence of CPSP was 37.6% among those with low (≤40) SPOC scores, 54.1% among those with intermediate (41-80) scores, and 81.7% among those with high (>80) scores. Addition of SPOC scores to an adjusted regression model to predict CPSP improved the c-statistic from 0.61 (95% CI 0.55-0.68) to 0.70 (95% CI 0.64-0.76, P=0.005 for the difference) and found the greatest risk was associated with high SPOC scores (OR 6.56,. Similarly, an adjusted regression model to predict pain interference with function at one yr (c-statistic 0.77, 95% CI 0.71-0.83) found the greatest risk for those with high SPOC scores (OR 10.10,. Conclusions: Patient's coping and expectations of recovery, as measured by the SPOC questionnaire, is an independent predictor of CPSP and pain interference one yr after traumatic tibial fracture. Future studies should explore whether these beliefs can be modified, and if doing so improves prognosis. Clinical trial registration: NCT 00038129

Patient coping and expectations predict recovery after major orthopaedic trauma

“…The calibration plots of the predicted and observed event probabilities showed a good agreement (Supplementary Appendix S4) (Tables 4 and 5). Reconstruction of all regression models using the original cut-off scores for the SPOC questionnaire ( 40, >40 to !80, and >80) 8 showed similar associations (Supplementary Appendices S5e8).…”

“…The tertiles calculated for the current study population of 1560 patients (low: 47; moderate: 48e73; high: !74) were a little different than the cut-offs derived from the population of 267 patients used to develop the SPOC questionnaire ( 40, >40 to !80, and >80). 8 We also constructed all regression models using the original cut-off scores for the SPOC questionnaire. Statistical analyses were performed using the R Statistical Package (R Foundation for Statistical Computing, Vienna, Austria) and SAS software, version 9.4 (SAS Institute Inc., Cary, NC, USA).…”

The Association Between Daily Posttraumatic Stress Symptoms and Pain Over the First 14 Days After Injury: An Experience Sampling Study

“…Although recent studies focus on acute assessments after minor injury, large gaps between assessments (e.g., initial assessments in hospital/1 week, then gaps until 6 weeks, 6 months, and 1 year postinjury) limit understanding of recovery trajectories and study populations have been in isolated injury subtypes (i.e., whiplash and/or motor vehicle accidents), limiting understanding in general injured patient populations. The subtle relationships between postinjury psychological processes and pain over the acute recovery period could be key in designing interventions to accelerate recovery …”

Chronic Postoperative Pain: Comprehending It to Intervene

“…The age of the patient has been correlated with the process of postoperative pain chronification in several studies. Younger patients are more likely to present with CPOP, 8,17,19,21,26 especially those under the age of 60 years. 9 The influence of gender as a risk factor has also been observed, 4 since females are more affected by CPOP.…”

“…9 The influence of gender as a risk factor has also been observed, 4 since females are more affected by CPOP. 9,17,19,21,26 In relation to ethnicity, non-Caucasian patients have been more associated with CPOP than other patients after hernia repair. 17 Genetic peculiarities have also been shown to participate in the genesis of CPOP, a field of study that has been slowly growing.…”