Psychological distress mediates the relationship between pain and disability in hand or wrist fractures
Date
2015
Authors
Ross, C.
Juraskova, I.
Lee, H.
Parkitny, L.
Stanton, T.R.
Moseley, L.G.
McAuley, J.H.
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Journal article
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Journal of Pain, 2015; 16(9):836-843
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Abstract
Upper limb fracture is a common musculoskeletal injury that 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-report 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, while each psychological distress variable was associated with pain (P<0.001), only depression (b1=0.27, P=0.03) and stress (b3=0.23, P=0.02) were significantly associated with disability, and fulfilled recommended criteria for establishing a mediating variable. Elevated 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.
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Copyright 2015 The American Pain Society