Psychological and Social Nature of Pain in Orthopaedics

Barth, Robert J.

doi:10.2106/jbjs.20.01954

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Psychological factors may contribute to orthopaedic pain, 13 and for individuals with scoliosis improvements in pain have been correlated with improved patient-reported self-image 4 . Some findings, however, challenge the suggestion of a psychological etiology for back pain in IS.…”

Section: Discussionmentioning

confidence: 99%

Exploring Correlations Between Pain and Deformity in Idiopathic Scoliosis With Validated Self-reported Pain Scores, Radiographic Measurements, and Trunk Surface Topographic Measurements

Cirrincione,

Thakur,

Zucker

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Up to 75% of patients with idiopathic scoliosis (IS) report back pain, but the exact contributors are unclear. This study seeks to assess how pain correlates with demographics, radiographic and surface topographic (ST) measurements, and patient-reported outcome measures (PROMs) in patients with IS. Methods: Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference (PI) and Scoliosis Research Society revised (SRS-22r) pain domain from an IRB approved prospectively collected registry containing patients 11 to 21 years old with IS were correlated (Spearman coefficients) with measurements from whole-body EOS radiography and ST scanning, PROMIS 1.0 PROMs, Trunk Appearance Perception Scale (TAPS), and SRS-22r domains. SRS-22r and PROMIS-PI were also compared between different sex, scoliosis severities, and primary curve locations with Mann-Whitney U or Kruskal-Wallis tests, and if significant differences were found, included with the 5 highest univariate correlated variables into stepwise multivariate linear regression models (P<0.05 to enter, P>0.1 to remove) predicting SRS-22r pain and PROMIS-PI. Results: One hundred and forty-nine patients (14.5 ± 2.0 y, body mass index 20.6 ± 4.1 kg/m2, 96 (64%) female, mean major coronal curve 40 ± 19 deg, range: 10 deg, 83 deg) reported mean PROMIS-PI of 42.2 ± 10.0 and SRS-22r pain of 4.4 ± 0.6. SRS-22r self-image was the most correlated variable with both SRS-22r pain (rho=0.519) and PROMIS-PI (rho=−0.594). Five variables, none of which were ST or radiographic measures, strongly predicted SRS pain domain (R=0.711, R2=0.505, N=138). Two variables (SRS-22r self-image and SRS-22r function) were utilized by a model correlated with PROMIS-PI (R=0.687, R2=0.463, N=124). Conclusions: SRS-22r function and self-image domains were more strongly correlated with SRS-22r pain and PROMIS-PI than any radiographic or ST measurements. Level of Evidence: Level II—retrospective study.

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Section: Discussionmentioning

confidence: 99%

Exploring Correlations Between Pain and Deformity in Idiopathic Scoliosis With Validated Self-reported Pain Scores, Radiographic Measurements, and Trunk Surface Topographic Measurements

Cirrincione,

Thakur,

Zucker

et al. 2023

Journal of Pediatric Orthopaedics

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“…[42][43][44][45] The results support the importance of surgeons considering the various dimensions of pain including psychological and social components when developing pain management strategies. 46,47 PROMs are uniquely suited to capture patient-specific predictors of postoperative pain control challenges that cannot be gleaned from EHR data. PRD ultimately could have broader uses within the opioid realm, facilitating identification of high-risk patients and development of individualized pain-management strategies.…”

Section: Plastic and Reconstructive Surgery • August 2023mentioning

confidence: 99%

Patient-Reported Data Augment Health Record Data for Prediction Models of Persistent Opioid Use after Elective Upper Extremity Surgery

Giladi

Shipp

Sanghavi

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Opioids play a role in pain management after surgery, but prolonged use contributes to developing opioid use disorder. Identifying patients at risk of prolonged use is critical for deploying interventions that reduce or avoid opioids; however, available predictive models do not incorporate patientreported data (PRD), and it remains unclear whether PRD can predict postoperative use behavior. The authors used a machine learning approach leveraging preoperative PRD and electronic health record data to predict persistent opioid use after upper extremity surgery. Methods: Included patients underwent upper extremity surgery, completed preoperative PRD questionnaires, and were prescribed opioids after surgery. The authors trained models using a 2018 cohort and tested in a 2019 cohort. Opioid use was determined by patient report and filled prescriptions up to 6 months after surgery. The authors assessed model performance using area under the receiver operating characteristic, sensitivity, specificity, and Brier score. Results: Among 1656 patients, 19% still used opioids at 6 weeks, 11% at 3 months, and 9% at 6 months. The XGBoost model trained on PRD plus electronic health record data achieved area under the receiver operating characteristic 0.73 at 6 months. Factors predictive of prolonged opioid use included income; education; tobacco, drug, or alcohol abuse; cancer; depression; and race. Protective factors included preoperative Patient-Reported Outcomes Measurement Information System Global Physical Health and Upper Extremity scores. Conclusions: This opioid use prediction model using preintervention data had good discriminative performance. PRD variables augmented electronic health record-based machine learning algorithms in predicting postsurgical use behaviors and were some of the strongest predictors. PRD should be used in future efforts to guide proper opioid stewardship.

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“…There is a growing recognition that the relationship between physical, mental, and social health is of relevance in patient care 1,2 . In orthopaedic surgery, for example, it is established that people who continue to request opioids long after the body has healed tend to have greater misconceptions about their symptoms and greater psychological distress, as most people discontinue opioids as soon as possible 3 .…”

mentioning

confidence: 99%