title: Chronic pain and disability after pelvic and acetabular fractures--assessment with the Mainz Pain Staging System.
abstract: BACKGROUND
  Chronic posttraumatic pelvic pain (PPP) after pelvic ring fractures impacts negatively on quality of life issues. This study aimed to more clearly identify and quantify the problem.
  
  
  METHODS
  For this cross-sectional study, patients were examined 52 (median) months after pelvic fractures. The following parameters were measured: pain chronicity (Mainz Pain Staging System [MPSS]), pain intensity (Numeric Rating Scale, 0-10), pelvic fracture outcome scores (Majeed, Pohlemann, and Bürk), pain severity (Chronic Pain Grading Questionnaire), pain-related interference with activities of daily living (Chronic Pain Grading Questionnaire), low back pain-related disability (Oswestry score), neuropathic pain (painDETECT), physical functioning (Short Form-12), and medical comorbidities (Weighted Illness Check List-20). Psychological distress was evaluated for anxiety and depression (Hospital Anxiety and Depression Scale) and mental quality of life (Short Form-12).
  
  
  RESULTS
  Sixty-nine patients had a total of 49 pelvic and 41 acetabular fractures; 70% underwent osteosynthesis. The prevalence of PPP was 64%. Prevalence weighted with the dysfunctional pain chronicity stages MPSS II and III was 48%. Patients with pelvic fracture types (AO classification) A, B, and C had PPP prevalences of 38%, 67%, and 90%, respectively. Pain chronicity stages (MPSS) were moderately to strongly correlated with pelvic pain intensity (r = 0.57), the three pelvic fracture outcome scores (r = -0.78 to -0.90), pain-related interference (r = 0.72), Oswestry score (r = 0.68), nerve injury and neuropathic pain (r = 0.52), reduced physical (r = -0.72) and mental functioning (r = -0.58), trauma-related comorbidity (r = 0.53), anxiety (r = 0.51), and depression (r = 0.67).
  
  
  CONCLUSIONS
  This study demonstrated that the intensity and prevalence of PPP are high even some 4 years after injury. The validated instruments MPSS (measuring pain chronicity) and Oswestry disability score proved to be appropriate for classifying outcome after pelvic ring fractures.
authors.affiliation: Department of Anesthesiology, University Medical Center Utrecht, The Netherlands. h.j.gerbershagen@umcutrecht.nl
authors.forename: Hans Jürgen
authors.initials: HJ
authors.lastname: Gerbershagen
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Dagtekin
authors.forename: Jörg
authors.initials: J
authors.lastname: Isenberg
authors.forename: Niels
authors.initials: N
authors.lastname: Martens
authors.forename: Enver
authors.initials: E
authors.lastname: Ozgür
authors.forename: Henning
authors.initials: H
authors.lastname: Krep
authors.forename: Rainer
authors.initials: R
authors.lastname: Sabatowski
authors.forename: Frank
authors.initials: F
authors.lastname: Petzke
mesh_terms: D000077:Acetabulum / Q000293:injuries*; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods*; D010384:Pelvic Bones / Q000293:injuries*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome