Incidence and prognostic factors of chronic pain after isolated musculoskeletal extremity injury.
BACKGROUND
Chronic pain in patients is usually related to an episode of pain following acute injury, emphasizing the need to prevent progression from acute to chronic pain. Multiple factors in the acute phase might be responsible for perpetuating the pain. The presentation of patients at the emergency department (ED) presents a prime opportunity to identify patients at high risk for chronic pain and to start appropriate treatment.


METHODS
The PROTACT study is a prospective follow-up study aiming to estimate the incidence and prognostic factors responsible for the development of chronic pain after musculoskeletal injury. Data including sociodemographic, pain, clinical, injury- or treatment-related and psychological factors of 435 patients were collected from registries and questionnaires at ED visit, 6-week, 3- and 6-month follow-up.


RESULTS
At 6 months post-injury, 43.9% of the patients had some degree of pain (Numeric Rating Scale (NRS) ≥1) and 10.1% had chronic pain (NRS ≥4). Patients aged over 40 years, in poor physical health, with pre-injury chronic pain, pain catastrophizing, high urgency level and severe pain at discharge were found to be at high risk for chronic pain.


CONCLUSIONS
Two prognostic factors, severe pain at discharge and pain catastrophizing, are potentially modifiable. The implementation of a pain protocol in the ED and the use of cognitive-behavioural techniques involving reducing catastrophizing might be useful.
Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
J G J
JG
Pierik
Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
M J
MJ
IJzerman
Emergency Department, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands.
M I
MI
Gaakeer
Biomedical Signals and Systems, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
M M R
MM
Vollenbroek-Hutten
Emergency Department and Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
A B
AB
van Vugt
Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
C J M
CJ
Doggen
D000328:Adult; D058443:Catastrophization / Q000453:epidemiology* / Q000523:psychology; D059350:Chronic Pain / Q000453:epidemiology* / Q000523:psychology; D004636:Emergency Service, Hospital; D005121:Extremities / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000453:epidemiology* / Q000523:psychology; D016017:Odds Ratio; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index