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. 2022 Jul:158:110915.
doi: 10.1016/j.jpsychores.2022.110915. Epub 2022 Apr 19.

Symptoms of depression and catastrophic thinking attenuate the relationship of pain intensity and magnitude of incapability with fracture severity

Aresh Al Salman  1 , Romil Shah  2 , Jacob E Thomas  3 , David Ring  4 , Tom J Crijns  2 , Stephen Gwilym  5 , Prakash Jayakumar  2
Affiliations

Symptoms of depression and catastrophic thinking attenuate the relationship of pain intensity and magnitude of incapability with fracture severity

Aresh Al Salman et al. J Psychosom Res. 2022 Jul.

Abstract

Objective: The relative association of pain intensity and magnitude of incapability with pathophysiology, accounting for psychological factors, is incompletely understood. Using moderation analysis, we assessed the association of pain intensity and magnitude of incapability (dependent variables) with fracture severity (independent variable) and the influence of symptoms of depression and catastrophic thinking (moderators) at early and later stages of recovery.

Methods: A cohort of 731 patients recovering from a shoulder, elbow, or wrist fracture, completed self-reported measures of pain intensity, upper extremity capability, symptoms of depression, and catastrophic thinking between 2 and 4 weeks after injury and again between 6 and 9 months after injury. Fracture severity was rated by clinicians, and we used multivariable regression analysis to examine interaction effects of fracture severity, depression, catastrophic thinking, pain intensity, and magnitude of incapability at early and later stages of recovery.

Results: Symptoms of depression and catastrophic thinking attenuate the relationship between pain intensity and fracture severity at earlier and later stages of recovery. Symptoms of depression and catastrophic thinking also attenuate the relationship between the magnitude of incapability and fracture severity, but only at early stages of recovery.

Conclusion: The relative divergence of pain intensity and magnitude of incapability from the level of fracture severity due to the moderating effects of unhelpful thinking and distress, signals a benefit to anticipating mental health opportunities during recovery after fracture. Fracture management can incorporate measures of unhelpful thinking and symptoms of distress to better address these opportunities and ensure comprehensive optimization of recovery.

Level of evidence: Level IIc, prognostic.

Keywords: Biological vs mental health; Biopsychosocial; Mental health; Patient reported outcome measures; Upper extremity fractures.

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