Psychological Factors Predict Disability and Pain Intensity After Skeletal Trauma

Vranceanu, Ana‐Maria; Bachoura, Abdo; Weening, Alexander A.; Vrahas, Mark; Smith, R. M.; Ring, David

doi:10.2106/jbjs.l.00479

Cited by 275 publications

(196 citation statements)

References 29 publications

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“…Psychological distress related to pain depends not only on the individual's awareness of the level of threat represented by the injury, but also the choice of coping strategies [24]. The patient's coping strategies such as catastrophization (the tendency to expect the worst to occur when pain is present, an approach that can be thought of as the opposite of ''coping'') and pain anxiety are normal protective responses to initial nociception [10], but patients who depend on maladaptive and ineffective strategies to cope with pain often become impaired by their pain and maintain an inactive lifestyle [25].…”

Section: Introductionmentioning

confidence: 99%

To What Degree Do Pain-coping Strategies Affect Joint Stiffness and Functional Outcomes in Patients with Hand Fractures?

Roh

Noh

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Patients with hand fractures often have pain, swelling, and stiffness in the joints of the hand, which may lead them to protect their hands, resulting in more stiffness and in delayed recovery. However, the effects of paincoping strategies and catastrophization (the tendency to expect the worst to occur when pain is present, an approach that can be thought of as the opposite of ''coping'') on functional recovery after hand fractures have not been investigated in depth. Questions/purposes Are preoperative catastrophization and anxiety in patients with hand fractures associated with (1) decreased grip strength; (2) decreased range of motion; and (3) increased disability at 3 and 6 months after surgical treatment for a hand fracture? Secondarily, we asked if there are other patient and injury factors that are associated with these outcomes at 3 and 6 months. Methods A total of 93 patients with surgically treated hand fractures were enrolled in this prospective study. Preoperative assessments measured coping strategies evaluated by measuring catastrophic thinking with the Pain Catastrophizing Scale and pain anxiety with the Pain Anxiety Symptom Scale. At 3 and 6 months postoperatively, grip strength, total active range of motion, and disability (Quick Disabilities of the Arm, Shoulder, and Hand score) were assessed. Bivariate and multivariate analyses were performed to identify patient demographic, injury, and coping skills factors that accounted for outcomes of strength, motion, and disability. Results Decreased grip strength was associated with catastrophic thinking (beta = À1.29 [95% confidence interval, À1.67 to À0.89], partial R 2 = 11%, p \ 0.001) and anxiety (beta = À0.83 [À1.16 to À0.50], partial R 2 = 7%, p = 0.007) at 3 months, but by 6 months, only anxiety (beta = À0.74 [À1.04 to À0.44], partial R 2 = 7%, p = 0.010) remained an important factor. Decreased total active range of motion was associated with pain catastrophizing (beta = À0.63 [À0.90 to À0.36], partial R 2 = 6 %, p = 0.024) and anxiety (beta = À0.28 [À0.42 to À0.14], partial R 2 = 3%, p = 0.035) at 3 months but not at 6 months. Similarly, increased disability was associated with pain catastrophizing (beta = 1.09 [1.39-0.79], partial R 2 = 12%, p \ 0.001) and anxiety (beta = 0.93 [1.21-

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Section: Introductionmentioning

confidence: 99%

To What Degree Do Pain-coping Strategies Affect Joint Stiffness and Functional Outcomes in Patients with Hand Fractures?

Roh

Noh

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Despite uncertainty regarding the long-term effectiveness of opioids for treating chronic musculoskeletal pain [35,43] and emerging evidence that preoperative opioid use is associated with greater pain, disability, and dissatisfaction after orthopaedic surgery [10,25,31,32,42,53], opioids continue to be prescribed. Although it is well established that high-risk opioid use (abuse or dependence) may result from prolonged opioid exposure during the preoperative period [57], little is known about its prevalence and effect in the perioperative orthopaedic surgery setting.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Menendez

Ring

Bateman

2015

Clinical Orthopaedics &Amp; Related Research

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309

176

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Background Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting. Questions/purposes We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.

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“…2014), or sustain severe orthopedic or bodily injury (Vranceanu et al. 2014) are at increased risk for traumatic stress. Service members and veterans who have a traumatic stress condition often have other problems, such as depression (Rojas et al.…”

Section: Introductionmentioning

confidence: 99%

Brain‐derived neurotropic factor polymorphisms, traumatic stress, mild traumatic brain injury, and combat exposure contribute to postdeployment traumatic stress

et al. 2015

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BackgroundIn addition to experiencing traumatic events while deployed in a combat environment, there are other factors that contribute to the development of posttraumatic stress disorder (PTSD) in military service members. This study explored the contribution of genetics, childhood environment, prior trauma, psychological, cognitive, and deployment factors to the development of traumatic stress following deployment.MethodsBoth pre‐ and postdeployment data on 231 of 458 soldiers were analyzed. Postdeployment assessments occurred within 30 days from returning stateside and included a battery of psychological health, medical history, and demographic questionnaires; neurocognitive tests; and blood serum for the D2 dopamine receptor (DRD2), apolipoprotein E (APOE), and brain‐derived neurotropic factor (BDNF) genes.ResultsSoldiers who screened positive for traumatic stress at postdeployment had significantly higher scores in depression (d = 1.91), anxiety (d = 1.61), poor sleep quality (d = 0.92), postconcussion symptoms (d = 2.21), alcohol use (d = 0.63), traumatic life events (d = 0.42), and combat exposure (d = 0.91). BDNF Val66 Met genotype was significantly associated with risk for sustaining a mild traumatic brain injury (mTBI) and screening positive for traumatic stress. Predeployment traumatic stress, greater combat exposure and sustaining an mTBI while deployed, and the BDNF Met/Met genotype accounted for 22% of the variance of postdeployment PTSD scores (R 2 = 0.22, P < 0.001). However, predeployment traumatic stress, alone, accounted for 17% of the postdeployment PTSD scores.ConclusionThese findings suggest predeployment traumatic stress, genetic, and environmental factors have unique contributions to the development of combat‐related traumatic stress in military service members.

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Psychological Factors Predict Disability and Pain Intensity After Skeletal Trauma

Abstract: We found that psychological factors that are responsive to cognitive behavioral therapy--catastrophic thinking, in particular--are strongly associated with pain intensity and disability in patients recovering from musculoskeletal trauma.

Cited by 275 publications

References 29 publications

To What Degree Do Pain-coping Strategies Affect Joint Stiffness and Functional Outcomes in Patients with Hand Fractures?

To What Degree Do Pain-coping Strategies Affect Joint Stiffness and Functional Outcomes in Patients with Hand Fractures?

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Brain‐derived neurotropic factor polymorphisms, traumatic stress, mild traumatic brain injury, and combat exposure contribute to postdeployment traumatic stress

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