Psychological factors are major predictors of chronic pain in trauma patients, say researchers

Can long-term pain and disability be predicted in individuals recovering from non-life-threatening orthopedic injuries? A team of Australian researchers writing in The Journal of Pain, the peer review journal of the American Pain Society, www.ampainsoc.org, says yes and believes psychological factors, such as pessimism about recovery and depression, are major predictors of chronic pain in trauma patients.

For their study, researchers from Monash University's Accident Research Centre evaluated 168 patients with a range of non-life threatening orthopedic injuries, many of which occurred in the workplace. More than half of the respondents reported persistent pain six months after their injuries and 87 percent said their pain interfered with normal work activities. The objective of the research was to examine factors contributing to the development of ongoing pain following healing of acute injuries and determine if early identification of those at risk for ongoing pain could be valuable for returning injured workers to full productivity.

The major findings reported were a high prevalence of pain six months following injury and the significant contribution of psychological and mood factors for increasing risks for chronic pain.

High initial pain intensity was a major factor predicting development of chronic pain, and the authors surmised that severe initial pain may initiate behaviors that lead to psychological distress. Those reporting high initial pain levels while hospitalized were more likely to have significant pain six months after discharge. Recovery expectations also play a role, as the study showed that those who believed they would not recover soon were nearly four times more likely to report pain-related disability after six months. Symptoms of depression, anxiety or stress post-injury also were identified as strong independent predictors of pain-related work disability. In addition, those injured at work were more likely to develop symptoms consistent with post-traumatic stress disorder, initiate litigation, and blame others for their injuries.

According to the authors, indentifying psychological factors contributing to long-term pain after traumatic injuries will help to assess functional outcomes in orthopedic injury patients as they return to work.