The Psychological Effects of Musculoskeletal Trauma

Abstract

Musculoskeletal injuries comprise a large percentage of hospital admissions for adults and often contribute to persistent daily pain as an illness; opioid dependence; disability; and complaints of increased depression, anxiety, and symptoms of post-traumatic stress disorder. The prevalence of depression and post-traumatic stress disorder after orthopaedic trauma has been found to be considerably greater than the general adult cohort. Soon after sustaining a fracture, psychological factors can predict pain and disability many months after injury, even after controlling for injury severity. Thus, early in the care of orthopaedic trauma, there exists an opportunity to improve overall health by attending to psychological and social concerns, along with physical health. Recent literature has identified clinically actionable subgroups within the orthopaedic trauma cohort that are at psychological risk after an injury. Improving positive factors such as resilience, social support, and self-efficacy via validated interventions such as Cognitive-Behavioral Therapy, mindfulness training, and other types of mindset training has helped people return to their daily routine. Raising awareness of the psychological effects of trauma among the orthopaedic community could improve post-treatment planning, increase referrals to appropriate nonmedical professionals, and implement earlier effective interventions.

Risk Factors for Developing Concurrent Posttraumatic Stress Injury After Work-Related Musculoskeletal Injury

“…Findings are consistent with previous research that has found that the nature of work and types of accidents and injuries workers experience are related to development of PTSI 1,5 . Our sample of workers with concurrent MSI and PTSI also reported worse general health and worse social functioning and had less attachment to the workplace (including being less likely to be working at admission and discharge from rehabilitation), which is consistent with previous research 3,4 .…”

“…Workers experiencing traumatic musculoskeletal injury (MSI) are at risk of developing posttraumatic stress injury (PTSI). 1 The prevalence of posttraumatic stress after acute orthopedic trauma varies from study to study, but a recent meta-analysis of patients with acute orthopedic injuries reported a weighted pooled prevalence of diagnosed posttraumatic stress disorder of 26% (95% confidence interval [CI], 19.0%–35.9%). 2 Workers with concurrent MSI and PTSI are also more likely to experience delayed recovery, including being less likely to return to work.…”

“…Previous research examining PTSI after MSI has identified a variety of salient risk factors related to the nature of the accident and injury, as well as clinical factors related to the acute injury. 1 , 4 A study of military personnel experiencing extremity long bone fracture found that lower extremity fracture, multiple fractures, and higher pain Visual Analog Scale (VAS) scores were associated with development of PTSI. 5 Other studies have identified that acute pain severity and associated psychological symptoms, such as catastrophizing, fear avoidance, low self-efficacy, and emotional problems, are also associated with development of PTSI symptoms.…”

“…Posttraumatic stress injury symptoms and chronic pain from MSI share common psychological vulnerability factors, such as previous exposure to trauma or physical injury or preexisting mental health conditions, which increase the risk for complicated outcomes. 1 Symptoms of pain and psychological trauma have been conceptualized as “mutually maintaining” at physiological, affective, and behavioral levels. 12 – 14 This means that each PTSI and MSI can serve to maintain and exacerbate symptoms of the other.…”

Anxiety symptoms and disorders in the first year after sustaining mild traumatic brain injury.

“…Having a serious injury might, in itself, be sufficient to increase the risk of suffering from anxiety, in fact a recent systematic review indicates that 11% to 56% of individuals who have sustained orthopedic trauma suffer from some form of anxiety symptoms up to 10 years after the injury (Breazeale, Conley, Gaiser, & Redeker, 2021). Pain, depression and PTSD are also common after musculoskeletal trauma (Kang, Ciminero, Parry, & Mauffrey, 2021). Future research could investigate the qualitative nature of anxiety sources after mTBI specifically, as well as common factors shared with other types of physical injuries.…”