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Predicting pain outcomes after traumatic musculoskeletal injury

Rosenbloom, Brittany N.; Katz, Joel; Chin, Kelly Y.W.; Haslam, Lynn; Canzian, Sonya; Kreder, Hans J.; McCartney, Colin J.L.

doi: 10.1097/j.pain.0000000000000580
Research Paper
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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.

General anxiety immediately after traumatic musculoskeletal injury and symptoms of posttraumatic stress 4 months after injury are associated with the development of moderate-to-severe neuropathic pain.

aDepartment of Anesthesia, Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada

bDepartment of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada

cDepartment of Orthopedics, Sunnybrook Health Sciences Centre, Toronto, Canada

dDepartment Psychology, Faculty of Health, York University, Toronto, Canada

eTrauma and Neurosurgery Program, St. Michael's Hospital, Toronto, Canada

fDepartment of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada. C.J.L. McCartney is now with The Ottawa Hospital, Ottawa, ON, Canada

Corresponding author. Address: Calumet College, York University, Room 308, 4700 Keele St, Toronto, ON M3J 1P3, Canada. Tel.: 416-813-8419; fax: 416-736-5814. E-mail address: bnrosen@yorku.ca (B.N. Rosenbloom).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received November 23, 2015

Received in revised form March 30, 2016

Accepted March 31, 2016

© 2016 International Association for the Study of Pain
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