The Effects of Pain, Anxiety, and Depression on Function After Severe Injury

Three-hundred and twenty seven (327) adults with a severe leg injury were studied to see the effects of pain, anxiety, and depression on physical function at home, at work, and at play. Measures for each effect were taken at regular intervals up to two years after the injury.

Most of the patients were men between the ages of 26 and 45 who had either broken a leg and/or damaged the soft tissues in a motor vehicle accident. The goal of the study was to gain a better understanding of the psychological factors affecting function in complex injuries.

This topic is important because when physical activities are restricted by injury, chronic disability can develop. Such conditions can have both personal as well as social implications. For example, only one out of every two patients goes back to work after severe leg injuries. Function limited by pain and psychologic distress are considered the main problem.

This study takes a closer look at the psychologic distress after injury and its effects. Most other studies examine the complex interactions among pain, psychologic distress, and physical function. This one tries to tease out how much of the disabling effects are from the psychologic aspects of severe injury.

First, they gathered data on patient characteristics (age, sex, education, marital status, economic status, race/ethnicity, and health insurance. Then they looked at the type and extent of injuries. Factors that might affect recovery were also reviewed. These included such things as level of preinjury health and exercise, smoking and drinking habits, and legal involvement or compensation for the injury.

Outcomes and psychologic distress were also measured using self-report questionnaires and surveys such as the Sickness Impact Profile (SIP), Brief Symptom Inventory (BSI), and Visual Analog Scale (VAS).

And here's what they found. Pain and psychologic/emotional distress both decrease patients' function. The effects are most noticeable during that first year after the injury.

Once the physical body has recovered as much as it can, then the effects of psychologic and emotional distress take on a more significant (and obvious) role in long-term recovery. As might be expected, the higher the psychologic distress, the lower the physical function. It appears that pain and negative mood affect level of function rather than the other way around (low function results in increased pain and negative mood).

What does all this mean for the patient? A comprehensive program to address all postinjury needs is required. Physical and emotional pain must both be treated in order to maximize function. Loss of control leads to anxiety and anxiety is linked with fear of pain. The end result is a self-imposed limitation on any movements or activities that might produce pain. This, in turn, reduces physical function and contributes to long-term chronic impairments or disability.

Paying attention to the psychologic needs of patients with complex/severe injuries is just as important as treating the physical wound, fracture, or other injury. This is true even when anxiety, depression, or other negative emotions are mild or moderate.

The focus on the emotional and psychologic aspects of recovery must begin early on for the best results. Health care professionals should also keep in mind that despite this approach, there will always be some patients who will have to learn how to live with disability that doesn't go away.

Reference: 

Stephen T. Wegener, et al. Psychological Distress Mediates the Effect of Pain on Function. In PAIN. June 2011. Vol. 152. No. 6. Pp. 1349-1357.

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