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J Pain. 2015 Sep;16(9):836-43. doi: 10.1016/j.jpain.2015.05.007. Epub 2015 Jun 11.

Psychological Distress Mediates the Relationship Between Pain and Disability in Hand or Wrist Fractures.

Author information

1
Neuroscience Research Australia, Sydney, Australia; University of California San Francisco, Madison Clinic for Pediatric Diabetes, San Francisco, California.
2
Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, University of Sydney, NSW, Australia.
3
Neuroscience Research Australia, Sydney, Australia; University of New South Wales Clinical School, Sydney, Australia.
4
University of Alabama at Birmingham, Birmingham, Alabama.
5
Neuroscience Research Australia, Sydney, Australia; University of South Australia, PainAdelaide, Adelaide, Australia.

Abstract

Upper limb fracture is a common musculoskeletal injury and can lead to marked pain-related disability. Unlike other common painful musculoskeletal conditions, such as low back pain, little consideration has been given to the role that psychological variables may play in explaining the relationship between pain and disability during early fracture recovery. This cross-sectional study aimed to determine if psychological distress (symptoms of depression, anxiety, and/or stress) mediate the relationship between pain and disability in acute hand/wrist fractures. Self-reported data from a consecutive sample of 594 patients with acute hand/wrist fracture were used. Mediation analyses were conducted to determine the role of depression, anxiety, and stress in the relationship between pain and disability, controlling for relevant demographic and fracture-related variables. Depression and stress, but not anxiety, significantly mediated the relationship between pain and disability. That is, although each psychological distress variable was associated with pain (P < .001), only depression (b1 = 0.27, P = .03) and stress (b3 = .23, P = .02) were significantly associated with disability and fulfilled recommended criteria for establishing a mediating variable. Increased depression and stress, but not anxiety, explain the relationship between pain and disability and may be novel targets for interventions designed to reduce pain-related disability after upper limb fracture. Perspective: This study presents the mediating effect of psychological distress on the relationship between pain and disability in acute upper limb fracture. These factors may be novel targets for interventions designed to reduce pain-related disability after acute fracture.

KEYWORDS:

Depression; disability; fracture; pain; psychological distress; stress

PMID:
26072389
DOI:
10.1016/j.jpain.2015.05.007
[Indexed for MEDLINE]

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