Citation

Rosenbloom BN, Katz J, Chin K, Haslam L, Canzian S, Kreder HJ, McCartney CJ. Pain 2016; 157(8): 1733-1743.

Affiliation

aInstitute of Medical Science, Department of Anesthesia, Faculty of Medicine, University of Toronto bSunnybrook Health Sciences Centre cDepartment of Psychology, Faculty of Health, York University dTrauma and Neurosurgery Program, St. Michael's Hospital eDepartment of Surgery, Faculty of Medicine, University of Toronto.

Copyright

(Copyright © 2016, Lippincott, Williams and Wilkins)

DOI

10.1097/j.pain.0000000000000580

PMID

27058677

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 following 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 following injury (p <.001) and symptoms of posttraumatic stress 4-months after injury (p <.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.

Language: en