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Clinical Significance of Pain at Hospital Discharge Following Traumatic Orthopedic Injury: General Health, Depression, and PTSD Outcomes at 1 Year

Archer, Kristin R. PhD, DPT; Heins, Sara E. BA; Abraham, Christine M. MA; Obremskey, William T. MD, MPH; Wegener, Stephen T. PhD; Castillo, Renan C. PhD

doi: 10.1097/AJP.0000000000000246
Original Articles

Objectives: The purpose of this study was to determine whether pain at hospital discharge is associated with general health and depression and posttraumatic stress disorder (PTSD) at 1 year following traumatic orthopedic injury.

Materials and Methods: This study prospectively enrolled 213 patients, 19 to 86 years of age, admitted to an academic level 1 trauma center for surgical treatment of a traumatic lower-extremity or upper-extremity orthopedic injury. Pain at hospital discharge was measured with the Brief Pain Inventory. At 1-year follow-up, physical and mental health was assessed with the SF-12 and depressive and PTSD symptoms with the 9-item Patient Health Questionnaire (PHQ-9) and PTSD Checklist-Civilian Version (PCL-C), respectively. Cut-off scores of 10 on the PHQ-9 and 44 on the PCL-C classified patients as having depression or PTSD.

Results: A total of 133 patients (62%) completed follow-up at 1 year. Responders and nonresponders did not differ significantly on baseline characteristics. Multivariable regression found that increased pain at discharge was significantly associated with depression (odds ratio=3.3; P<0.001) and PTSD (odds ratio=1.4; P=0.03) at 1 year, after controlling for age, education, injury severity score, and either depressive or PTSD symptoms at hospital discharge. Early postoperative pain was not a significant risk factor for long-term physical and mental health.

Discussion: Findings highlight the importance of early screening for uncontrolled postoperative pain to identify patients at high risk for poor psychological outcomes and who could benefit from more aggressive pain management. Results suggest early interventions are needed to address pain severity in patients with orthopedic trauma.

Departments of *Orthopaedic Surgery

Physical Medicine and Rehabilitation, School of Medicine, Vanderbilt University, Nashville, TN

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

§Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, MD

Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

Presented in part at the Orthopaedic Trauma Association 29th Annual Meeting, Phoenix, Arizona, October 12, 2013.

Supported with funds from the Orthopaedic Trauma Association, Rosemont, IL and by CTSA award No. UL1TR000445 from the National Center for Advancing Translational Sciences, Bethesda, MD. The authors declare no conflict of interest.

Reprints: Kristin R. Archer, PhD, DPT, Department of Orthopaedic Surgery, School of Medicine, Vanderbilt University, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232 (e-mail:

Received June 25, 2014

Received in revised form May 5, 2015

Accepted April 7, 2015

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