Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy


Health and Rehabilitation Sciences


MacDermid, Joy C.

2nd Supervisor

Walton, David M.

Joint Supervisor


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

Summary for Lay Audience

Pain that persists for a long time after an injury is a common problem. Currently, we do not have effective treatment options. To discover better treatment options, it is important to understand what contributes to the persistence of pain. This thesis includes three papers. In the first paper, we reviewed published papers to examine whether complex regional pain syndrome (CRPS) can run in families. We concluded that it is possible for CRPS to run in families (a familial sub-type). Those that reported this sub-type also reported more severe presentation and got the disease at a younger age. However, we do not know if this is because of genetics or shared environments between family members. As CRPS can happen following common injuries such as wrist fractures, in the second study we examined recovery patterns in people with wrist fractures. We found that there are three recovery patterns: 1) people that recover quickly, 2) people that take a little bit longer to recover, and 3) people that continue to have pain for a long time. We found that a larger number of people in the third group had depression compared to the other two groups. In the third study, we examined the relationship between distress right after any type of injury and the amount of pain one year later. We found that most people do not have pain one year later regardless of how much distress they had after the injury. However, some people continued to have pain. In this group of people, higher levels of distress were associated with higher levels of pain one year later. Overall, the results of these three papers tell us that long-lasting pain is more than just the injury to our body parts, but familial factors, depression, and distress can contribute as well.