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Pain-related fear, catastrophizing and pain in the recovery from a fracture
Örebro University, School of Law, Psychology and Social Work. (Center for Health And Medical Psychology, CHAMP)ORCID iD: 0000-0001-5359-0452
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0002-9456-2527
Dept. of Orthopedics, Örebro University Hospital, Örebro, Sweden.
Dept. of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0002-7335-469X
2010 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 1, no 1, p. 38-42Article in journal (Refereed) Published
Abstract [en]

Background and aims: Pain-related fear and catastrophizing are prominently related to acute and persistent back pain, but little is known about their role in pain and function after a fracture. Since fractures have a clear etiology and time point they are of special interest for studying the process of recovery. Moreover, fracture injuries are interesting in their own right since patients frequently do not recover fully from them and relatively little is known about the psychological aspects. We speculated that catastrophizing and fear-avoidance beliefs might be associated with more pain and poorer recovery after an acute, painful fracture injury.

Methods: To this end we conducted a prospective cohort study recruiting 70 patients with fractures of the wrist or the ankle. Participants completed standardized assessments of fear, pain, catastrophizing, degree of self-rated recovery, mobility and strength within 24 h of injury, and at 3- and 9-month follow-ups. Participants were also categorized as having high or low levels of fear-avoidance beliefs by comparing their scores on the first two assessments with the median from the general population. To consolidate the data the categorizations from the two assessments were combined and patients could therefore have consistently high, consistently low, increasing, or decreasing levels.

Results: Results indicated that levels of fear-avoidance beliefs and catastrophizing were fairly low on average. At the first assessment 69% of the patients expected a full recovery within 6 months, but in fact only 29% were fully recovered at the 9-month follow-up. Similarly, comparisons between the affected and non-affected limb showed that 71% of those with a wrist fracture and 58% with an ankle fracture were not fully recovered on grip strength and heel-rise measures. Those classified as having consistently high or increasing levels of fear-avoidance beliefs had a substantially increased risk of more intense future pain (adjusted OR = 3.21). Moreover, those classified as having consistently high or increasing levels of catastrophizing had an increased risk for a less than full recovery of strength by almost six-fold (adjusted OR = 5.87).

Conclusions and implications: This is the first investigation to our knowledge where the results clearly suggest that fear and catastrophizing, especially when the level increases, may be important determinants of recovery after an acute, painful, fracture injury. These results support the fear-avoidance model and suggest that psychological factors need to be considered in the recovery process after a fracture.

Place, publisher, year, edition, pages
Amsterdam, Netherlands: Elsevier, 2010. Vol. 1, no 1, p. 38-42
Keywords [en]
Fear-avoidance beliefs, Catastrophizing, Prospective, Fractures, Acute pain
National Category
Medical and Health Sciences Occupational Therapy
Identifiers
URN: urn:nbn:se:oru:diva-41540DOI: 10.1016/j.sjpain.2009.09.004OAI: oai:DiVA.org:oru-41540DiVA, id: diva2:780578
Note

Conflicts of interests: The authors have not declared any conflicts of interests related to this study.

Acknowledgements: Financial support was kindly given by the Örebro University Hospital, Örebro University and the Karolinska Institute.

Available from: 2015-01-14 Created: 2015-01-14 Last updated: 2018-04-24Bibliographically approved

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Linton, Steven J.Buer, NinaHarms-Ringdahl, Karin

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School of Law, Psychology and Social WorkSchool of Health and Medical Sciences, Örebro University, Sweden
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Scandinavian Journal of Pain
Medical and Health SciencesOccupational Therapy

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