Elsevier

The Journal of Hand Surgery

Volume 39, Issue 11, November 2014, Pages 2258-2264.e2
The Journal of Hand Surgery

Scientific article
Effect of Anxiety and Catastrophic Pain Ideation on Early Recovery After Surgery for Distal Radius Fractures

https://doi.org/10.1016/j.jhsa.2014.08.007Get rights and content

Purpose

To evaluate the effects of preoperative anxiety and catastrophic pain ideation on perceived disability and objective measures after distal radius fracture surgery.

Methods

A total of 121 patients with distal radius fractures treated with volar plate fixation were enrolled. The wrist range of motion (ROM), grip strength, and perceived disability as measured by the Michigan Hand Questionnaire (MHQ) score were assessed 4, 12, and 24 weeks after surgery. To evaluate psychological factors related to pain, catastrophic pain ideation was measured using the Pain Catastrophizing Scale (PCS) and pain anxiety was measured using the Pain Anxiety Symptom Scale (PASS). Then relative contributions of pain anxiety and catastrophic pain ideation and other clinical parameters to functional recovery in terms of grip strength, ROM, and MHQ score were assessed.

Results

An increase in the PCS score was associated with the wrist ROM and grip strength only at week 4, whereas an increase in the PASS score was associated with the wrist ROM at week 4 and grip strength at weeks 4 and 12. According to a multivariate regression analysis, an increase in the PCS score was associated with a decrease in grip strength, ROM, and MHQ score at week 4; and an increase in the PASS score was associated with a decrease in grip strength, ROM, and MHQ score at week 4 and grip strength and MHQ score at week 12. At week 24, only age and fracture severity were associated with the MHQ score. In addition, age was associated with grip strength and fracture type was associated with ROM.

Conclusions

Preoperative PCS and PASS were significantly associated with delayed recovery as evidenced by scores on both objective and subjective measures of function. Given these relationships, it becomes important to assess preoperative PCS and PASS and address issues for patients at risk with brief psychosocial intervention early in the recovery process.

Type of study/level of evidence

Prognostic II.

Section snippets

Materials and Methods

In this prospective cohort study, a total of 143 consecutive patients 20 years and older with a DRF treated by volar plate fixation between January 2013 and October 2013 were invited to participate. These patients were recruited from a tertiary care university hospital serving as a regional emergency trauma center, and the institutional review board of the university approved this study. All patients were recruited by a research assistant (trained nurse) when they attended the orthopedic

Results

All ROMs, grip strength, and MHQ scores showed a trend toward continued improvements up to 24 weeks (Table 2).

There was a significant decrease in grip strength in patients with increasing patient age, PCS score, PASS score, or severe fracture type at week 4, whereas an increase in patient age or PASS score was associated with a decrease in grip strength at week 12. At week 24, only an increase in age was associated with grip strength (Table 3). A severe fracture type and an increased PCS or

Discussion

Pain is a dominant predictor of upper extremity–specific health status after the operative treatment of DRFs.10 In addition, psychological factors, not pain per se, cause disability in patients with chronic musculoskeletal pain.22 Although psychological mechanisms underlying pain are reportedly to be associated with chronic pain, the effects of these mechanisms on outcomes of acute fractures have not been well demonstrated. Results of this study suggest that preoperative pain coping (PCS and

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    This work was supported by a grant from Gachon University, Gil Medical Center, Incheon, South Korea (to Y.H.R.).

    No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

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