title: Patient coping and expectations about recovery predict the development of chronic post-surgical pain after traumatic tibial fracture repair.
abstract: BACKGROUND
  The association of patient expectations about recovery with the development of chronic post-surgical pain (CPSP) is uncertain.
  
  
  METHODS
  Three hundred and fifty-nine patients enrolled in the SPRINT trial completed the Somatic Preoccupation and Coping (SPOC) questionnaire six weeks after a traumatic tibial fracture repair. The SPOC questionnaire measures patients' somatic complaints, coping, and optimism for recovery. Using adjusted models, we explored the association of SPOC scores with ≥ mild CPSP and ≥ moderate pain interference with activity at one yr after surgery.
  
  
  RESULTS
  Of 267 tibial fracture patients with data available for analysis, 147 (55.1%) reported CPSP at one yr. The incidence of CPSP was 37.6% among those with low (≤40) SPOC scores, 54.1% among those with intermediate (41-80) scores, and 81.7% among those with high (>80) scores. Addition of SPOC scores to an adjusted regression model to predict CPSP improved the c-statistic from 0.61 (95% CI 0.55-0.68) to 0.70 (95% CI 0.64-0.76, P=0.005 for the difference) and found the greatest risk was associated with high SPOC scores (OR 6.56, 95% CI 2.90-14.81). Similarly, an adjusted regression model to predict pain interference with function at one yr (c-statistic 0.77, 95% CI 0.71-0.83) found the greatest risk for those with high SPOC scores (OR 10.10, 95% CI 4.26-23.96).
  
  
  CONCLUSIONS
  Patient's coping and expectations of recovery, as measured by the SPOC questionnaire, is an independent predictor of CPSP and pain interference one yr after traumatic tibial fracture. Future studies should explore whether these beliefs can be modified, and if doing so improves prognosis.
  
  
  BACKGROUND
  NCT 00038129.
authors.affiliation: Department of Anaesthesia, University of Toronto, 123 Edward Street, 12th Floor, Toronto, Ontario, Canada M5G 1E2 The Michael G. DeGroote Institute for Pain Research and Care Population Health Research Institute, Hamilton, Canada james.khan@medportal.ca.
authors.forename: J S
authors.initials: JS
authors.lastname: Khan
authors.affiliation: Department of Clinical Epidemiology and Biostatistics Department of Medicine and Population Health Research Institute, Hamilton, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
authors.affiliation: Department of Clinical Epidemiology and Biostatistics Department of Anaesthesia, McMaster University, Hamilton, Canada Population Health Research Institute, Hamilton, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: LeManach
authors.affiliation: Department of Clinical Epidemiology and Biostatistics The Michael G. DeGroote Institute for Pain Research and Care Department of Anaesthesia, McMaster University, Hamilton, Canada.
authors.forename: J W
authors.initials: JW
authors.lastname: Busse
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000523:psychology*; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*
keywords: chronic pain; postoperative pain; tibial fractures