Berben, S.A.A.

Doggen, C.J.M.

Gaakeer, M.I.

IJzerman, M.J.

Pierik, J.G.J.

Vugt, A.B. van

Pierik, Jorien

Doggen, Catharina Jacoba Maria

van Vugt, A.B.

IJzerman, Maarten Joost

University of Twente Research Information

More information:Jorien Pierik, MScPhD candidateW: www.utwente.nl/mb/htsrE: J.G.J.Pierik@utwente.nlFracture Luxation Distortion ContusionBIOMEDICAL	AND	PSYCHOSOCIAL	FACTORS	ASSOCIATED	WITH	SEVERE	ACUTE	MUSCULOSKELETAL	PAINBACKGROUND	AND AIMSTUDY	DESIGN	AND	POPULATION1.University	Twente,	Health	Technology	&	Services	Research,	MIRA	institute	for	Biomedical	Technology	and	Technical	Medicine,	Enschede	2.	University	Medical	Center	Utrecht,	Emergency	Department,	Utrecht	3.	Radboud	University	Nijmegen,	Regional	Emergency	Healthcare	Network,	Nijmegen		4.	Medisch	Spectrum	Twente,	Emergency	Department	and	Department	of	Surgery,	Enschede.	The	NetherlandsPierik	JGJ1,	Doggen	CJM1,	Gaakeer	MI2,	Berben	SA3,		van	Vugt	AB4,	IJzerman	MJ1• Whereas	acute	musculoskeletal	pain	is	a	common	presentation	in	emergency	care,	it	often	remains	undertreated.		• Pain	is	known	as	a	multi‐dimensional	experience	with	biomedical	and	psychosocial	components• Our	goal	is	to	identify	high‐risk	patients	for	severe	pain	who	may	benefit	most	from	early	pain	management	and	additional	pain	relief.• The	prospective		cohort	study	PROTACT	includes	408	adult	patients	who	were	admitted	to	the	Emergency	Department	(ED)	with	injury	due	to	blunt	trauma	to	the	extremities	of	the	musculoskeletal	system.	• Characteristics	of	patients,	including	psychosocial‐,	biomedical	and	health	related	factors,	and	perception	of	pain	were	collected	using	questionnaires	and	hospital	registration.	• Odds	ratios	(OR)	with	95%	Confidence	intervals	were	calculated	and	adjusted	(OR	adj)	for	other	factors	using	unconditional	logistic	regressionRESULTSDISCUSSION• Several	biomedical	and	psychosocial	factors	are	associated	with	an	increased	risk	of	severe	pain.	• An	early	focus	on	these	patients	is	important	to	preven	to	prevent	delayed	pain	management	and	oligoanalgesia.Pain	intensity	at	ED	admission	and	ED	discharge.	The	prevalence	of	severe	musculoskeletal	pain	(NRS≥7)	was	58.6%	at	admission	and	46.1%	at	discharge.	Characteristics	of	408	acute	musculoskeletal	trauma	patientsN	(%) Mean	(SD)Demographic	characteristicsAge																						 45.2	(15.3)Women 237	(58.1%)Pain	characteristicsPain	as	main	reason 289	(70.8%)ED	visit	within	2	hours	after	onset	of	pain 193	(47.3%)ED	visit	within	24	hours	after	onset	of	pain 344	(84.3%)Pain	(score)	at	arrival	ED	(	patient) 99% 6.4	(2.4)Pain	(score)	at	discharge	ED	(patient) 98% 5.7	(2.5)Pain	(score)	according	to	MTS			(nurse) 100% 3.9	(1.3)Potential	risk	and	protective	factors	associated	with	severe	pain	(NRS≥7)Severe	pain	at	admission	 Severe	pain	at	dischargeN n OR (95%	CI) N n OR (95%	CI)Age			 18‐39			 148 79 ⊺ 148 64 ⊺40‐49 75 41 1.05 (0.60‐1.84)	 75 37 1.28 (0.73‐2.23)50‐69 185 119 1.57* (1.01‐2.48) 185 87 1.17 (0.75‐1.80)Gender																																	Men 171 82 ⊺ 171 66 ⊺Women 237 157 2.13* (1.42‐3.19) 237 122 1.69* (1.13‐2.52)Kinesiofobia No 197 109 ⊺ 197 80 ⊺Yes 144 99 1.78* (1.13‐2.79) 144 80 1.83* (1.18‐2.82)Anxiety No 361 206 ⊺ 361 161 ⊺Yes 37 28 2.34* (1.07‐5.10) 37 23 2.04* (1.02‐4.09)Depression No 377 222 ⊺ 377 177 ⊺Yes 18 11 1.10 (0.42‐2.89) 18 8 0.90 (0.35‐2.34)Pain	catastrophizing No 324 191 ⊺ 324 151 ⊺Yes 22 18 3.13* (1.04‐9.47) 22 16 3.06* (1.17‐8.01)Education level High 180 93 ⊺ 180 72 ⊺Low			 216 136 1.48 (1.00‐2.23) 216 110 1.56* (1.04‐2.32)Smoking No 330 186 ⊺ 330 143 ⊺Yes 65 48 2.19* (1.21‐3.96) 65 41 2.23* (1.29‐3.87)Arrival by ambulance					No 360 203 ⊺ 360 163 ⊺Yes 43 33 2.55* (1.22‐5.34) 43 22 1.27 (0.67‐2.38)Income	out	of	work		 Low 105 66 ⊺ 105 55 ⊺Modal 61 36 0.85 (0.45‐1.62) 61 28 0.77 (0.41‐1.45)High 62 30 0.55 (0.24‐1.05) 62 20 0.43* (0.23‐0.83)No	work 128 80 0.99 (0.58‐1.68) 128 61 0.83 (0.49‐1.39)Injury type																	Fracture 296 170 ⊺ 296 128 ⊺Luxation 13 9 1.67 (0.50‐5.54) 13 4 0.58 (0.18‐1.94)Distortion 56 33 1.06 (0.60‐1.90) 56 29 1.41 (0.80‐2.50)Contusion 35 22 1.25 (0.61‐2.59) 35 24 2.52* (1.21‐5.25)Muscle rupture 8 5 1.24 (0.29‐5.27) 8 4 1.31 (0.32‐5.54)Independent	predictors	of	severe	pain	at	admission	(n=339)		ORadj (95%	CI)Age# 1.00 (0.99‐1.01)Gender			 Men ⊺Women 2.46* (1.54‐3.92)Smoking No ⊺Yes 2.32* (1.19‐4.53)Kinesiofobia No ⊺Yes 1.66* (1.04‐2.67)Arrival by ambulance No				 ⊺Yes 1.96 (0.89‐4.45)0204060No pain Minimal, mild andmoderate painSevere and verysevere painPercentage of patients  Severe and very severe pain  (NRS 7‐10)Minimal, mild and moderate pain  (NRS 1‐6)No pain (NRS 0)At dischargeIndependent	predictors	of	severe	pain	at	discharge	(n=315)ORadj (95%	CI)Age# 1.00 (0.99‐1.02)Pain	catastrophizing# 1.04* (1.00‐1.07)Gender			 Men ⊺Women 1.63* (1.01‐2.66)Smoking No ⊺Yes 2.06* (1.07‐3.98)Kinesiofobia No ⊺Yes 1.50 (0.95‐2.67)Injury type																																																		Fracture ⊺Luxation 0.99 (0.25‐3.94)Distortion 1.61 (0.81‐3.20)Contusion 4.24 (1.55‐11.64)Muscle rupture 1.07 (0.21‐5.12)⊺	=	reference	group*	=	category	is	significantly	different	with	the	reference	group#=	category	is	continuous	in	model

English

Biomedical and psychosocial factors associated with severe acute musculoskeletal pain

NARCIS 

http://doc.utwente.nl/87799/1/Poster_EFICSEVERE_PAIN_%5BCompatibility_Mode%5D.pdf

Biomedical and psychosocial factors associated with severe acute musculoskeletal pain

Abstract

Similar works

Full text

Available Versions

University of Twente Research Information

NARCIS