(228) - Predicting trajectories of disability and quality of life in youth with acute musculoskeletal pain

Abstract

Prior studies have demonstrated that a sizeable proportion (35%) of youth with acute musculoskeletal (MSK) pain do not recover and continue with persistent MSK pain. Little is known about the biopsychosocial factors that predict the trajectory of recovery over time. To fill this gap, we tested how changes in psychological symptoms, sleep quality, and pain inhibition over 3 months post injury, predicted changes in disability and quality of life (QOL) over that same time period. Participants were 69 youth with new-onset MSK pain (ages 10–17) taking part in a longitudinal study examining risk for developing chronic pain. Youth were recruited from the emergency department or orthopedic clinic after presenting for evaluation of a new-onset musculoskeletal pain complaint (e.g., leg, back, arm pain). Participants attended two in-person lab visits, the first within one month after pain-onset and a second at four month follow-up. During each visit youth completed questionnaires assessing pain, disability, sleep and mood symptoms (pain catastrophizing, pain-related fear, depressive symptoms). Conditioned pain modulation was assessed using an experimental paradigm. Linear mixed effects models controlling for sex and pain intensity were used to examine changes in psychological, behavioral factors, and pain modulation over 3 months as predictors of longitudinal pain-related disability and QOL outcomes. In support of hypotheses, results revealed that increases in depressive symptoms (β = .26, P < .001) and pain-related fear (β = .24, P < .05) over 3 months predicted increases in pain-related disability over that same time period. Similarly, increases in depressive symptoms over time predicted a worsening of QOL (β = −.83, P < .001). Contrary to hypotheses, changes in sleep quality, pain catastrophizing and pain modulation over time were not associated with longitudinal changes in disability or QOL. Findings highlight the importance of depressive symptoms and pain-related fear in short-term recovery following acute injury and point to intervention targets.