Chronic Pain Following Musculoskeletal Injuries: Where Do Familial Factors, Depression, and Distress Fit in?
Abstract
Background: Currently, there is a paucity of effective therapeutic options for chronic pain. A better understanding of the factors that can contribute to chronic pain development and maintenance can lead to more informed prevention and management strategies.
Purpose: The driving force for this thesis comes from the biopsychosocial model of pain. The main purpose was to investigate the contribution of various psychosocial factors to chronic pain with the following objectives: 1) to systematically review the literature on the existence of a familial sub-type of complex regional pain syndrome (fCRPS); 2) CRPS can follow injuries such as distal radius fractures (DRFs), therefore the second objective was to assess recovery trajectories of patients following DRFs and assess the contribution of various characteristics; 3) to examine the effect of post-trauma distress on pain one year following musculoskeletal injuries.
Results: There is a potential (<25%) for the existence of fCRPS. People with this sub-type may suffer from more severe symptoms and earlier age at onset. Following DRFs, a significantly higher proportion of people with depression were found in the non-recovery group (24%) compared to the slow-recovery (16%, p=0.04) and the rapid-recovery group (8%, p=0.03). Following musculoskeletal injuries, a subset of people continue to have persisting pain. In this subset of people, higher levels of distress were associated with higher levels of pain 12 months later.
Conclusion: Familial factors, depression, and post-trauma distress all have the potential to contribute to chronic pain development and maintenance. The results of this thesis provide further evidence for the biopsychosocial model of chronic pain.
Keywords Chronic pain; musculoskeletal injuries; biopsychosocial; familial; depression; distress