Cited by 315Musculoskeletal pain and rehabilitationPosttraumatic Stress Disorder ResearchBone fractures and treatments

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Psychological Factors Predict Disability and Pain Intensity After Skeletal Trauma

Vranceanu, Ana-Maria, Bachoura, Abdo, Weening, Alexander, Vrahas, Mark, Smith, R. Malcolm, Ring, David·2014·Journal of Bone and Joint Surgery

DOI 10.2106/jbjs.l.00479

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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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Authors: Vranceanu, A.-M., Bachoura, A., Weening, A., Vrahas, M., Smith, R. M., & Ring, D.
Affiliations: Massachusetts General Hospital (US)
ORCID: Vranceanu, Ana-Maria
Bachoura, Abdo
Vrahas, Mark
Smith, R. Malcolm
Ring, David
Venue: Journal of Bone and Joint Surgery
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2014-02-05
Volume: 96
Issue: 3
Pages: e20
ISSN: 0021-9355 (ISSN-L)
1535-1386
DOI: 10.2106/jbjs.l.00479
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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Health Sciences › Medicine › Orthopedics and Sports Medicine › 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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Psychological Factors Predict Disability and Pain Intensity After Skeletal Trauma

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