Psychosocial Factors Predict Pain and Physical Health After Lower Extremity Trauma

Abstract

Background There has been increasing evidence to support the importance of psychosocial factors to poor outcomes after trauma. However, little is known about the contribution of pain catastrophizing and fear of movement to persistent pain and disability. Questions/purposes Therefore, we aimed to determine whether (1) high pain catastrophizing scores are independently associated with pain intensity or pain interference; (2) high fear of movement scores are independently associated with decreased physical health; and (3) depressive symptoms are independently associated with pain intensity, pain interference, or physical health at 1 year after accounting for patient characteristics of age and education. Methods Of 207 eligible patients, we prospectively enrolled 134 patients admitted to a Level I trauma center for surgical treatment of a fracture to the lower extremity. Sixty percent of patients (80 of 134) had an isolated lower extremity injury and the remainder sustained additional minor injury to the head/spine, abdomen/thorax, or upper extremity. Pain catastrophizing was measured with the Pain Catastrophizing Scale, fear of movement with the Tampa Scale for Kinesiophobia, and depressive symptoms with the Patient Health Questionnaire. Pain and physical health outcomes were assessed with the Brief Pain Inventory and the SF-12, respectively. Assessments were completed at 4 weeks and 1 year after hospitalization. Multiple variable hierarchical linear regression analyses were used to address study hypotheses. One hundred ten patients (82%)

Feasibility and acceptability of telephone‐delivered cognitive‐behavioral‐based physical therapy for patients with traumatic lower extremity injury

“…The Lower Extremity Assessment Project study first reported on the importance of low self‐efficacy (the patient's confidence in being able to resume life activities) to long‐term outcomes following traumatic lower‐extremity injury (Bosse et al, ), with more recent evidence supporting the association between self‐efficacy and pain at hospital discharge (Archer, Abraham, Song, & Obremskey, ). Archer et al and others have also found that patients who display pain catastrophizing behavior (tendency to focus on, ruminate, and magnify pain sensations) and/or fear of movement are at risk for more severe pain and disability up to 2 years after trauma (Archer, Abraham, & Obremskey, ; Archer, Abraham, et al, ; Nota et al, ; Vranceanu et al, ). Overall, studies suggest that psychosocial risk factors, especially those related to pain beliefs and behaviors, are potential targets for cognitive and behavioral strategies that address maladaptive beliefs and avoidance of activities (Vranceanu et al, ; Zale, Ring, & Vranceanu, ).…”

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

“…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.…”

Assessing psychosocial profile in the physical therapy setting

“…Rumination causes a patient to perpetually dwell on the pain, magnification is an unhealthy focus and awareness of the pain and its potential side effects, and helplessness is feeling unable to do anything to reduce the intensity of the pain (Sullivan, ; Sullivan, Bishop, & Pivik, ). High levels of catastrophizing are associated with increased pain intensity (Archer et al, ; Das De, Vranceanu, & Ring, ; Edwards, Smith, Stonerock, & Haythornthwaite, ; Khan et al, ; Ozkan, Zale, Ring, & Vranceanu, ), pain interference (Archer et al, ; Leeuw, Goossens, et al, ), disability (Das De et al, ; Ozkan et al, ; Teunis, Bot, Thornton, & Ring, ), opioid use (Helmerhorst, Vranceanu, Vrahas, Smith, & Ring, ), and risk of developing chronic pain (Flaskerud, ; Khan et al, ).…”

“…However, PTs across the U.S. have demonstrated significant inconsistency in identifying risk factors for chronic pain and disability (Beneciuk, Lentz, He, Wu, & George, ). Physical examination findings are the primary focus for most PTs, but research to date suggests that the most important prognostic factors are psychosocial in nature (Archer, Abraham, & Obremskey, ; Archer, Castillo, Wegener, Abraham, & Obremskey, ; Noehren et al, ; Piva, Fitzgerald, Wisniewski, & Delitto, ; Vargas‐Prada & Coggon, ). In‐fact, psychosocial factors have stronger associations with the transition from acute to chronic pain than any other factor (Foster & Delitto, ; Katz & Seltzer, ; Williams, ).…”

“…Bergbom, Boersma, Overmeer, and Linton () conducted a prospective cohort study in 297 patients with LBP and found that elevated levels of pain catastrophizing and depression were predictors of increased disability, pain intensity, and number of health care visits. Another prospective study in subjects who sustained a lower extremity fracture showed that pain catastrophizing and depression 4 weeks after surgery was associated with increased pain intensity and pain interference 1 year after surgical fixation (Archer et al, ). These data demonstrate the importance of evaluating psychosocial constructs when developing management strategies (Bergbom et al, ).…”