Predicting pain outcomes after traumatic musculoskeletal injury

Abstract

Traumatic musculoskeletal injury results in a high incidence of chronic pain; however, there is little evidence about the nature, quality, and severity of the pain. This study uses a prospective, observational, longitudinal design to (1) examine neuropathic pain symptoms, pain severity, pain interference, and pain management at hospital admission and 4 months after traumatic musculoskeletal injury (n = 205), and (2) to identify predictors of group membership for patients with differing moderate-to-severe putative neuropathic pain trajectories. Data were collected on mechanism of injury, injury severity, pain (intensity, interference, neuropathic quality), anxiety (anxiety sensitivity, general anxiety, pain catastrophizing, pain anxiety), depression, and posttraumatic stress while patients were in-hospital and 4 months after injury. A third of patients had chronic moderate-to-severe neuropathic pain 4 months after injury. Specifically, 11% of patients developed moderate-to-severe pain by 4 months and 21% had symptoms immediately after injury that persisted over time. Significant predictors of the development and maintenance of moderate-to-severe neuropathic pain included high levels of general anxiety while in-hospital immediately after injury (P < 0.001) and symptoms of posttraumatic stress 4 months after injury (P < 0.001). Few patients had adequate pharmacological, physical, or psychological pain management in-hospital and at 4 months. Future research is needed among trauma patients to better understand the development of chronic pain and to determine the best treatment approaches.

Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: a prospective study

“…Additionally, more information about the context in which the acute pain occurred (e.g., initial pain ratings, injury severity) and assessment of factors relevant to injury-related pain (e.g., post-traumatic stress) may be valuable. For example, research in adults hospitalized after traumatic injuries has identified post-traumatic stress and injury variables as relevant to pain outcomes [31]. …”

“…Additional data suggests post-injury anxiety, depression, posttraumatic stress symptoms, and pain catastrophizing predict pain persistence after acute injury [2; 31]. The developmental and interpersonal factors unique to childhood may limit the generalizability of these adult findings, making it critical to conduct similar prospective studies of youth with new-onset MSK pain.…”

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

“…Specifically, up to 24% of injured trauma patients report a new‐onset psychiatric disorder at 12 months postinjury, and an estimated 10%–40% develop clinically significant symptoms characteristic of posttraumatic stress disorder (PTSD), including intrusive experiences (e.g., nightmares, flashbacks, or triggers), avoidance of trauma‐related stimuli, negative changes in beliefs and feelings, and increased physiological arousal and reactivity . These psychological reactions are associated with chronic posttraumatic pain, even more so than injury severity or characteristics . Additionally, activation of support networks immediately after a traumatic event enhances adjustment to pain, and poor social support predicts adverse psychological outcomes …”

The Role of Negative Affect on Headache‐Related Disability Following Traumatic Physical Injury

“…Taken together, psychiatric symptoms may be involved in the transition from episodic to chronic migraine and more generally from acute to chronic pain . Yet, it remains unknown whether the relationship between acute psychological symptoms and headache‐related disability emerges soon after traumatic physical injury, and whether these psychological symptoms may be involved in the transition to chronic disability.…”