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Psychosocial Factors Predict Post-Operative Pain Relief
Kartemus O. Heary, MSCI1, Alex W.K. Wong, PhD1, Madeline R. Thompson, BA1, Stephen C.L. Lau1, Jana Dengler, MD2, Christine B. Novak, PhD2, Lara W. Crock, MD1, Susan E. Mackinnon, MD1.
1Washington University School of Medicine in St. Louis, St. Louis, MO, USA, 2Univerisity of Toronto, Toronto, ON, Canada.

Purpose:
Injuries of peripheral nerves that affect sensory and motor functions may be accompanied by neuropathic pain and adverse psychosocial consequences. Our primary study aim was to explore the predictive relationships of pain and psychosocial variables (impact of quality of life (QoL), sadness, depression, anger, and hopefulness). Secondarily, we aimed to identify the unidirectional and bidirectional relationships among these variables.
Methods:
A retrospective review of prospectively collected data was used to identify patients with peripheral nerve injury (n = 331). Participants completed visual analog scales for self-reported pain, QoL, sadness, depression, anger, and hopefulness. These data were collected at each visit; all participants had at least one follow-up visit. Multilevel modeling was used to analyze concurrent and lagged relationships among pain and psychosocial variables.
Results:
Increased concurrent pain was significantly associated with increased impact of QoL, sadness, depression, and anger (p<0.001). Decreased concurrent hopefulness (p=0.001) was significantly associated with increased pain. Lagged impact of QoL (p<0.001) and anger (p<0.02) scores were predictive of pain at the next visit. Lagged pain scores were predictive of subsequent scores for impact of QoL, sadness, depression, anger, and hopefulness (p<0.001; p=0.03; p=0.008; p=0.01; and p=0.03, respectively). Participants reporting "no comment" when queried about childhood trauma were more likely to have increased pain at the same visit and subsequent visits than individuals who responded with "yes" or "no."
Conclusions:
Our study identified the predictive relationships where psychosocial factors could be used to foretell pain levels at subsequent visits. The results also yielded information that portrays the predict nature of pain on psychosocial factors. The findings of this study shed light on the importance of capturing alternative measures such as psychosocial factors when treating patients with peripheral nerve disorders. Surgeons should utilize the measurement of psychosocial factors with visual analog scales to evaluate outcomes following nerve surgery.


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