Psychological Factors Predict Disability and Pain Intensity After Skeletal Trauma
Abstract
Background: The aims of this study were to (1) estimate the prevalence of clinical depression and posttraumatic stress disorder (PTSD) one to two months (Time 1) and five to eight months (Time 2) after musculoskeletal trauma and (2) determine the cross-sectional and longitudinal relationship of psychological variables (depression, PTSD, catastrophic thinking, and pain anxiety) at Time 1 to musculoskeletal disability and pain intensity at Time 1 and Time 2, after accounting for injury characteristics and demographic variables. Methods: Patients with one or more fractures that had been treated operatively completed measures of depression, PTSD, pain anxiety, catastrophic thinking, musculoskeletal disability (the Short Musculoskeletal Function Assessment [SMFA]), and pain (the Numerical Rating Scale) at rest and during activity at Time 1 (152 patients) and at Time 2 (136 patients). Additional explanatory variables included injury severity, use of opioid pain medication at Time 1, and multiple or single injuries. Results: The screening criteria for an estimated diagnosis of clinical depression were met by thirty-five of the 152 patients at Time 1, and twenty-nine of the 136 patients at Time 2. Screening criteria for an estimated diagnosis of PTSD were met by forty-three of the 152 patients at Time 1 and twenty-five of the 136 patients at Time 2. Cross-sectional hierarchical linear regression models that included multiple injuries, scores of the Abbreviated Injury Scale, and self-reported opioid use explained between 24% and 29% of the variance in pain and disability, respectively, at Time 1. After the addition of psychological variables, the model explained between 49% and 55% of the variance. Catastrophic thinking (as measured with use of the Pain Catastrophizing Scale) at Time 1 was the sole significant predictor of pain at rest, pain during activity, and disability (as measured with use of the SMFA) at Time 2. Conclusions: We found that psychological factors that are responsive to cognitive behavioral therapy—catastrophic thinking, in particular—are strongly associated with pain intensity and disability in patients recovering from musculoskeletal trauma. Level of Evidence: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence. Peer Review: This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. It was also reviewed by an expert in methodology and statistics. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.
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Psychosocial factors can predict disability in individuals with hand and upper limb injuries.
“In addition to pathophysiology, psychosocial factors can predict disability in individuals with hand and upper limb injuries [5,6].”
Health anxiety is associated with increased pain perception and functional impairment.
“Health anxiety is associated with increased pain perception and functional impairment [28, 35, 36].”
From What are the Implications of Excessive Internet Searches for Medical Information by Orthopaedic Patients? (2019) · cites this paper as [35]
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Berube, M., Choinière, M., Laflamme, Y. G., & Gélinas, C. (2016) · International Journal of Orthopaedic and Trauma Nursing · doi:10.1016/j.ijotn.2016.04.002 · Cited by 39 · see citing works
Factors associated with pain intensity and physical limitations after lateral ankle sprains.
Briet, J. P., Houwert, R., Hageman, M., Hietbrink, F., Ring, D., & Verleisdonk, E. (2016) · Injury · doi:10.1016/j.injury.2016.09.016 · Cited by 34 · see citing works
Self-citationPre-injury depression and anxiety in patients with orthopedic trauma and their treatment
Haupt, E. T., Vincent, H. K., Harris, A. B., Vasilopoulos, T., Guenther, R. T., Sharififar, S., & Hagen, J. E. (2018) · Injury · doi:10.1016/j.injury.2018.03.024 · Cited by 38 · see citing works
Sacks, H., Stepan, J., Wessel, L., & Fufa, D. (2019) · Journal of Hand Surgery-American Volume · doi:10.1016/j.jhsa.2019.01.010 · Cited by 37 · see citing works
Golkari, S., Teunis, T., Ring, D., & Vranceanu, A. (2015) · Psychosomatics · doi:10.1016/j.psym.2015.03.008 · Cited by 37 · see citing works
Self-citationImplementing psychosocial programming at a level 1 trauma center: results from a 5-year period
Simske, N. M., Rivera, T., Breslin, M. A., Hendrickson, S. B., Simpson, M., Kalina, M. J., Ho, V. P., & Vallier, H. A. (2020) · Trauma Surgery & Acute Care Open · doi:10.1136/tsaco-2019-000363 · Cited by 36 · see citing works
The Psychological Effects of Musculoskeletal Trauma
Kang, K. K., Ciminero, M. L., Parry, J. A., & Mauffrey, C. P. (2021) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-20-00637 · Cited by 36 · see citing works
Oflazoglu, K., Mellema, J. J., Menendez, M. E., Mudgal, C. S., Ring, D., & Chen, N. C. (2015) · The Journal Of Hand Surgery · doi:10.1016/j.jhsa.2015.11.019 · Cited by 36 · see citing works
Self-citationFactors Associated with Greater Pain Intensity
Menendez, M. E., & Ring, D. (2015) · Hand Clinics · doi:10.1016/j.hcl.2015.08.004 · Cited by 35 · see citing works
Self-citationPosttraumatic Stress Disorder Associated With Orthopaedic Trauma
Lee, C., Choi, C. H., Yoon, S.-Y., & Lee, J. K. (2014) · Journal of Orthopaedic Trauma · doi:10.1097/bot.0000000000000255 · Cited by 35 · see citing works
Fischerauer, S. F., Talaei-Khoei, M., Vissers, F. L., Chen, N., & Vranceanu, A.-M. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.11.006 · Cited by 35 · see citing works
Self-citationMeijer, D. T., Deynoot, B. D. J. G., Stufkens, S. A. S., Sierevelt, I. N., Goslings, J. C., Kerkhoffs, G. M. M. J., & Doornberg, J. N. (2019) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000000623 · Cited by 35 · see citing works
Epidemiology of mental health conditions in incoming division I collegiate athletes
Sarac, N. J., Sarac, B. A., Pedroza, A. D., & Borchers, J. R. (2018) · The Physician and Sportsmedicine · doi:10.1080/00913847.2018.1427412 · Cited by 33 · see citing works
van Leeuwen, W. V., van der Vliet, Q. V. D., Janssen, S., Heng, M., Ring, D., & Vranceanu, A.-M. (2016) · Injury · doi:10.1016/j.injury.2016.02.018 · Cited by 30 · see citing works
Self-citationAssociation Between Opioid Intake and Disability After Surgical Management of Ankle Fractures
Finger, A., Teunis, T., Hageman, M., Ziady, E. R., Ring, D., & Heng, M. M. (2017) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-16-00505 · Cited by 32 · see citing works
Self-citationCognitive Behavioral Therapy for Chronic Pain
Vranceanu, A.-M., Stone, M. T., Wallace, T., & Kulich, R. (2017) · Springer eBooks · doi:10.1007/978-3-319-29294-6_5 · Cited by 49 · see citing works
Self-citationHouwen, T., de Munter, L., Lansink, K. W. W., & de Jongh, M. A. C. (2022) · Journal of Patient-Reported Outcomes · doi:10.1186/s41687-022-00440-3 · Cited by 30 · see citing works
Talaei‐Khoei, M., Fischerauer, S., Jha, R., Ring, D., Chen, N. C., & Vranceanu, A. (2017) · Journal of Behavioral Medicine · doi:10.1007/s10865-017-9891-6 · Cited by 30 · see citing works
Self-citationJochimsen, K. N., Noehren, B. W., Mattacola, C. G., Stasi, S. D., Duncan, S. T., & Jacobs, C. A. (2021) · Journal of Athletic Training · doi:10.4085/1062-6050-139-20 · Cited by 31 · see citing works
Menendez, M. E., Thornton, E. R., Kent, S. E., Kalajian, T. A., & Ring, D. (2015) · International Orthopaedics · doi:10.1007/s00264-015-2779-6 · Cited by 30 · see citing works
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Mental Health in Patients Undergoing Orthopaedic Surgery
Sharma, A. K., Elbuluk, A. M., Gkiatas, I. S., Kim, J. M., Sculco, P. K., & Vigdorchik, J. M. (2021) · JBJS Reviews · doi:10.2106/jbjs.rvw.20.00169 · Cited by 29 · see citing works
The Relationship Between Catastrophic Thinking and Hand Diagram Areas
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Self-citationPain-related psychological issues in hand therapy
Hamasaki, T., Pelletier, R., Bourbonnais, D., Harris, P., & Choinière, M. (2018) · Journal of Hand Therapy · doi:10.1016/j.jht.2017.12.009 · Cited by 28 · see citing works
Ramo, B. A., Collins-Jones, T. L., Thornberg, D. C., Klinkerman, L., Rathjen, K. E., & Jo, C.-H. (2022) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.22.00258 · Cited by 31 · see citing works
A Systematic Review of Outcome Measures Assessing Disability Following Upper Extremity Trauma
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Self-citationGopinath, B., Jagnoor, J., Kifley, A., Nicholas, M. K., Blyth, F., Kenardy, J. A., Craig, A. R., & Cameron, I. D. (2018) · Journal of Pain · doi:10.1016/j.jpain.2018.11.011 · Cited by 27 · see citing works
Jayakumar, P., Teunis, T., Vranceanu, A., Lamb, S. E., Williams, M. A., Ring, D., & Gwilym, S. E. (2019) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000000928 · Cited by 27 · see citing works
Self-citationPatient Satisfaction Is Improved With Exposure to Trauma Recovery Services
Simske, N. M., Benedick, A., Rascoe, A. S., Hendrickson, S. B., & Vallier, H. A. (2019) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-19-00266 · Cited by 27 · see citing works
Resources for Patient Mental Health and Well-being after Orthopaedic Trauma
Obey, M. R., & Miller, A. N. (2022) · Journal of Orthopaedics and Trauma · doi:10.1097/bot.0000000000002445 · Cited by 23 · see citing works
Modarresi, S., Suh, N., Walton, D. M., & MacDermid, J. C. (2019) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2019.07.012 · Cited by 26 · see citing works
Trauma recidivism is pervasive and is associated with mental and social health opportunities
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Gonzalez, A. I., Kortlever, J. T. P., Brown, L. E., Ring, D., & Queralt, M. (2021) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000001635 · Cited by 24 · see citing works
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Risk Factors for Posttraumatic Stress Disorder in Acute Trauma Patients
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Emerging Medical Technologies and Their Use in Bionic Repair and Human Augmentation
Manero, A. C., Rivera, V., Fu, Q., Schwartzman, J. D., Gibbs, H. P., Shah, N., Gandhi, D. A., White, E., Crawford, K. E., & Coathup, M. J. (2024) · Bioengineering · doi:10.3390/bioengineering11070695 · Cited by 21 · see citing works
- Authors
- Vranceanu, A.-M., Bachoura, A., Weening, A., Vrahas, M., Smith, R. M., & Ring, D.
- Affiliations
- Massachusetts General Hospital (US)
- Venue
- Journal of Bone and Joint Surgery
- Published
- 2014-02-05
- Volume
- 96
- Issue
- 3
- Pages
- e20
- ISSN
- 0021-9355 (ISSN-L)
- 1535-1386
- OpenAlex
- W2032527834
- Cited by
- 315
- References
- 41
- Citations by year
- 2026: 12 · 2025: 20 · 2024: 23 · 2023: 22 · 2022: 34 · 2021: 40 · 2020: 32 · 2019: 31 · 2018: 26 · 2017: 23 · 2016: 17 · 2015: 26 · 2014: 9
- FWCI
- 18.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Bone and Joint Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Bone fractures and treatments
- Keywords
- musculoskeletal injuries, fracture, major depressive disorder, post-traumatic stress disorder, catastrophic thinking, pain-related anxiety, pain intensity, musculoskeletal impairment, psychological factors, cognitive behavioral therapy, opioid use, injury severity, Short Musculoskeletal Function Assessment, pain catastrophizing, postoperative recovery, prognostic factors, polytrauma, Abbreviated Injury Scale, cognitive appraisal of pain
- MeSH terms
- Adaptation, Psychological, Analgesics, Opioid, Anxiety, Cross-Sectional Studies, Depressive Disorder, Female, Persons with Disabilities, Humans, Longitudinal Studies, Male, Middle Aged, Musculoskeletal System, Pain Measurement, Stress Disorders, Post-Traumatic, Wounds and Injuries, Catastrophization
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