title: Predicting pain outcomes after traumatic musculoskeletal injury.
abstract: Traumatic musculoskeletal injury results in a high incidence of chronic pain; however, there is little evidence about the nature, quality, and severity of the pain. This study uses a prospective, observational, longitudinal design to (1) examine neuropathic pain symptoms, pain severity, pain interference, and pain management at hospital admission and 4 months after traumatic musculoskeletal injury (n = 205), and (2) to identify predictors of group membership for patients with differing moderate-to-severe putative neuropathic pain trajectories. Data were collected on mechanism of injury, injury severity, pain (intensity, interference, neuropathic quality), anxiety (anxiety sensitivity, general anxiety, pain catastrophizing, pain anxiety), depression, and posttraumatic stress while patients were in-hospital and 4 months after injury. A third of patients had chronic moderate-to-severe neuropathic pain 4 months after injury. Specifically, 11% of patients developed moderate-to-severe pain by 4 months and 21% had symptoms immediately after injury that persisted over time. Significant predictors of the development and maintenance of moderate-to-severe neuropathic pain included high levels of general anxiety while in-hospital immediately after injury (P < 0.001) and symptoms of posttraumatic stress 4 months after injury (P < 0.001). Few patients had adequate pharmacological, physical, or psychological pain management in-hospital and at 4 months. Future research is needed among trauma patients to better understand the development of chronic pain and to determine the best treatment approaches.
authors.affiliation: Department of Anesthesia, Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.|Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Brittany N
authors.initials: BN
authors.lastname: Rosenbloom
authors.affiliation: Department of Anesthesia, Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.|Department Psychology, Faculty of Health, York University, Toronto, Canada.
authors.forename: Joel
authors.initials: J
authors.lastname: Katz
authors.affiliation: Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Kelly Y W
authors.initials: KYW
authors.lastname: Chin
authors.affiliation: Department of Anesthesia, Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.|Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: Haslam
authors.affiliation: Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, Canada.
authors.forename: Sonya
authors.initials: S
authors.lastname: Canzian
authors.affiliation: Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, Canada.|Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada. C.J.L. McCartney is now with The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Kreder
authors.affiliation: Department of Anesthesia, Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.|Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Colin J L
authors.initials: CJL
authors.lastname: McCartney
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D058443:Catastrophization / Q000523:psychology; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis* / Q000209:etiology*; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000150:complications* / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology