Highlights
- •This study examined the mediation of pain and disability by psychological distress in fracture.
- •Depression is important to understand the relationship between pain and disability.
- •Stress is important to understand the relationship between pain and disability.
- •Depression and stress may be important targets for future research on acute pain.
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.
Key words
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Article info
Publication history
Published online: June 10, 2015
Accepted:
May 28,
2015
Received in revised form:
May 17,
2015
Received:
March 12,
2015
Footnotes
This study was funded by the Australian National Health and Medical Research Council (NHMRC) Project grant ID 630431. G.L.M. supported by NHMRC Fellowship ID 1045322. T.R.S. supported by NHMRC Fellowship ID 1054041. L.P. supported by NHMRC scholarship 1017607 and an IASP International Trainee Fellowship funded by the Scan|Design Foundation.
There are no known conflicts of interest associated with this study.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
