Doggen, C.J.M.

Gaakeer, M.I.

IJzerman, M.J.

Pierik, J.G.J.

Vollenbroek-Hutten, M.M.R.

Vugt, A.B. van

Pierik, Jorien

IJzerman, Maarten Joost

van Vugt, A.B.

Vollenbroek-Hutten, Miriam Marie Rosé

Doggen, Catharina Jacoba Maria

NARCIS 

Incidence and predictors of chronic pain after musculoskeletal trauma

Incidence and predictors of chronic pain after musculoskeletal injury

University of Twente Research Information

More information: Jorien Pierik, MSc PhD candidate W: www.utwente.nl/mb/htsr E: J.G.J.Pierik@utwente.nl  Fracture Luxation Distortion Contusion INCIDENCE AND PREDICTORS OF CHRONIC PAIN AFTER  MUSCULOSKELETAL TRAUMA BACKGROUND AND AIM STUDY DESIGN AND POPULATION 1.University Twente, Health Technology & Services Research, MIRA institute for Biomedical Technology and Technical Medicine, Enschede   2. Medisch Spectrum Twente, Emergency Department and Department of Surgery, Enschede 3.  University Twente, Biomedical Signals and Systems, MIRA institute for Biomedical Technology and Technical Medicine,  Enschede 4. Admiraal De Ruyter Ziekenhuis, Emergency Department, Goes, The Netherlands -TOWARDS PREVENTING CHRONIC PAIN-   • Acute musculoskeletal pain is one of the primary complaints of patients in the Emergency Department (ED).  • Multiple factors within this acute pain phase may be responsible for transition from acute to chronic pain.  • The aim is to find prognostic factors that will give us the ability to target high-risk patients in the emergency setting and provide them with appropriate treatment to prevent chronic musculoskeletal pain • In a prospective cohort study (PROTACT) adult patients with musculoskeletal extremity injury  due to blunt trauma who attend the ED of Medisch Spectrum Twente,  the Netherlands were followed for six months.  • Characteristics of  patients, including psychosocial-, biomedical and health related factors, and perception of pain were collected from hospital registration and questionnaires at ED-visit, 6 weeks- 3 -and 6 months follow-up.  RESULTS DISCUSSION • In the PROTACT-study 43.9 % of patients still have pain six months after trauma.   • Potentially modifiable factors, such as severe pain at discharge, kinesiophobia and anxiety might be addressed through intervention in emergency setting to prevent chronic pain.  Pierik JGJ1, IJzerman MJ1, Van Vugt AB2,  Vollenbroek-Hutten MMR3, Gaakeer MI4 Doggen CJM1   Characteristics of 435 patients Women, n (%) 263 (42.8%) Age, mean (SD) 47.4 (14.8) Months follow-up  period, mean (min-max) (SD)  7.4 (5.0-14.0)   (1.7) Pain ± 6 months after trauma, n (%) 191 (43.9%) Pain interference in daily activity ± 6 months after trauma, n (%) 160 (36.8%) Pain and pain interference after six months follow-up.  The incidence of chronic pain (NRS ≥1) after injury was 43.9%. More than three-quarter of these patients had also pain interference with their daily activities.    Pain intensity at discharge, severe pain Anxiety Kinesiophobia Pain catastrophizing  Surgery Fracture Chronic pain before injury Pain interference before injury Age (ref: 18-29);        30 - 39          40 – 49         50 - 59          60 - 69 0,1 1 10 100OR adjusted with 95% CI                                                                                                                                                                                                                           Part of the candidate predictors associated with pain (NRS≥ 1) ±   6 months after trauma   Chronic pain OR (95% CI) Sex                                                                                              Men  (ref.) 67/172 1            Women 124/263 1.39 (0.95-2.07)  Age                                                                                        18- 29  (ref.) 23/79 1            30 - 39  21/49 1.82 (0.87-3.85)            40 – 49 35/83 1.77 (0.92-3.41)            50 - 59  58/111 2.66 (1.45-4.91)            60 - 69 54/113 2.23 (1.21-4.10) Pain level at discharge ED                               No severe pain (ref.) 87/243 1                                                        Severe pain [NRS≥7] 104/192 2.12 (1.44-3.12) Anxiety                                                                                         No (ref.) 132/392 1                     Present 28/41 3.06 (1.54-6.08) Depression                                                                                  No (ref.) 176/413 1        Present 14/20 2.71 (1.00-7.35) Kinesiophobia                                                                            No (ref.) 79/231 1        Present  105/183 2.59 (1.74-3.86) Pain catastrophizing                                                                No (ref.) 175/404 1        Present  11/14 4.80 (1.32-17.46) Educational level                                                                   High (ref.) 59/144 1                                         Middle 107/227 1.29 (0.85-1.96)                                         Low 24/62 0.91 (0.50-1.67) Injury site                                                       Lower extremities (ref.) 97/215 1                                            Upper extremities 94/220 0.92 (0.50-1.67) Chronic pain before injury                                                     No (ref.) 131/345 1                                                               Present 59/88 3.32 (2.02-5.45) Pain interferes with normal activities                None/little (ref.) 165/389 1  Moderately/quite a bit/extremely 26/37 3.34 (1.60-6.94) Surgery                                                                                         No (ref.) 127/326 1           Yes 61/102 2.33 (1.48-3.67) Compensation status                                                                No (ref.) 163/397 1          Yes 27/34 5.54 (2.36-13.00) Trauma caused                                      By chance/own (reference) 163/383 1        By others 21/41 1.42 (0.73-2.70) Type of injury,                                                         Non-fracture (ref.) 37/107 1  Fracture 154/328 1.67 (1.06-2.64) Analgetic use in ED                                                                   No (ref.) 102/275 1                                                                                                             Yes 89/160 2.13 (1.43-3.16)  Urgency level                                                                 Standard (ref.) 117/301 1                                                                                             Urgent  60/114 1.74 (1.13-2.70)       Very urgent 14/19 3.67 (1.37-9.81) 0102030405060No pain(NRS 0)Minimal pain(NRS 1-2)Mild pain(NRS 3-4)Moderate pain(NRS 5-6)Severe pain(NRS 7-8)Percentage of patients (%) Very severe pain with daily activitySevere pain with daily activityModerate pain with daily activityMild pain with daily activityMinimal pain with daily activityNo pain with daily activityIndependent predictors of chronic pain 

English

 1.University of Twente, Enschede, 2. Medisch Spectrum Twente, Enschede  3. Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands  EuSEM 2014  Incidence and predictors of chronic pain after musculoskeletal injury  Pierik J.G.J1, IJzerman M.J. 1, Van Vugt A.B.2, Vollenbroek-Hutten M.M.R.1,  Gaakeer M.I.3, Doggen C.J.M.1 Background & aim   intervention Methods  Design: prospective cohort study (one year follow-up)  Study population: 435 adult patients with isolated injury due to blunt trauma to the extremities of the musculoskeletal system   Setting: emergency department of Medisch Spectrum Twente  26 potential predictors  The primary outcome at six months follow-up: chronic pain (NRS≥ 4)    Results incidence of chronic pain  43 out of 435 patients (9.9%) developed chronic pain (NRS≥4)  43.9% of the patients had some degree of pain  0246810Mean pain intensity (NRS) Non-chronic patientsChronic patients0,0%10,0%20,0%30,0%40,0%50,0%60,0%NRS 0 NRS 1 NRS 2 NRS 3 NRS 4 NRS 5 NRS 6 NRS 7 NRS 8Percentage of patients Results six predictors independently associated with chronic pain Probability of developing chronic pain= 1/ (1+exp (-(-4.02 + 0.75*(age_≥40 years) + 0.64* (pain at discharge_severe) + 1.15*(pain catastrophizing_present) + 1.38*(chronic pain before injury_present) +0.62* (urgency level_urgent or very urgent) + 0.54* (physical health_poor)).   0,1 1 10OR adjusted C-statistic: 0.81 (95% CI 0.74-0.88).   Pain at discharge (severe) Pain catatrophizing (present) chronic pain before injury (present) Age (>40 years) Urgency level (urgent or very urgent) Physical health (poor) Thank you for your attention!  For any questions: j.g.j.pierik@utwente.nl   Conclusion Almost 10% of patients had chronic pain (NRS≥ 4) six months after musculoskeletal extremity injury &      43.9% of the patients had some degree of pain.  Only 2 out of the 6 predictors, severe pain at discharge and pain catastrophizing, are potentially modifiable.    

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Incidence and predictors of chronic pain after musculoskeletal injury

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