Psychological factors predict disability and pain intensity after skeletal trauma.
BACKGROUND
The aims of this study were to (1) estimate the prevalence of clinical depression and posttraumatic stress disorder (PTSD) one to two months (Time 1) and five to eight months (Time 2) after musculoskeletal trauma and (2) determine the cross-sectional and longitudinal relationship of psychological variables (depression, PTSD, catastrophic thinking, and pain anxiety) at Time 1 to musculoskeletal disability and pain intensity at Time 1 and Time 2, after accounting for injury characteristics and demographic variables.


METHODS
Patients with one or more fractures that had been treated operatively completed measures of depression, PTSD, pain anxiety, catastrophic thinking, musculoskeletal disability (the Short Musculoskeletal Function Assessment [SMFA]), and pain (the Numerical Rating Scale) at rest and during activity at Time 1 (152 patients) and at Time 2 (136 patients). Additional explanatory variables included injury severity, use of opioid pain medication at Time 1, and multiple or single injuries.


RESULTS
The screening criteria for an estimated diagnosis of clinical depression were met by thirty-five of the 152 patients at Time 1, and twenty-nine of the 136 patients at Time 2. Screening criteria for an estimated diagnosis of PTSD were met by forty-three of the 152 patients at Time 1 and twenty-five of the 136 patients at Time 2. Cross-sectional hierarchical linear regression models that included multiple injuries, scores of the Abbreviated Injury Scale, and self-reported opioid use explained between 24% and 29% of the variance in pain and disability, respectively, at Time 1. After the addition of psychological variables, the model explained between 49% and 55% of the variance. Catastrophic thinking (as measured with use of the Pain Catastrophizing Scale) at Time 1 was the sole significant predictor of pain at rest, pain during activity, and disability (as measured with use of the SMFA) at Time 2.


CONCLUSIONS
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.
Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, One Bowdoin Square, Boston, MA 02114.
Ana-Maria
AM
Vranceanu
Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring@partners.org.
Abdo
A
Bachoura
Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring@partners.org.
Alexander
A
Weening
Orthopaedic Trauma Service, Massachusetts General Hospital, 55 Fruit Street, Suite 3C, Boston, MA 02114.
Mark
M
Vrahas
Orthopaedic Trauma Service, Massachusetts General Hospital, 55 Fruit Street, Suite 3C, Boston, MA 02114.
R Malcolm
RM
Smith
Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring@partners.org.
David
D
Ring
D000223:Adaptation, Psychological; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001007:Anxiety / Q000209:etiology; D058443:Catastrophization / Q000517:prevention & control / Q000523:psychology; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000209:etiology*; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System / Q000293:injuries*; D010147:Pain Measurement; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*; D014947:Wounds and Injuries / Q000523:psychology / Q000601:surgery
D000701:Analgesics, Opioid