Post-traumatic Pain Research Articles

The Moderating Effect of Religious Involvement on the Relationship Between PTSD Symptoms and Physical Pain in U.S. Veterans and Active Duty Military

The relationship between posttraumatic stress disorder (PTSD) symptom severity and pain is well known in veterans and active duty military (V/ADM). This study examines the buffering effect of religiosity on that relationship. A multisite study was conducted involving 585 V/ADM from across the United States. Multidimensional measures of religiosity, PTSD symptoms, depression/anxiety were administered, along with physical pain on a 0 to 10 visual analog scale. Bivariate and multivariate relationships were examined, along with the moderating effects of religiosity. PTSD symptoms were significantly related to pain level (r = 0.44), a relationship that was only slightly weaker among highly religious (r = 0.34) vs. nonhighly religious (r = 0.48). In multivariate analyses, the interaction between religiosity and PTSD severity on pain was not significant, although stratified analyses indicated a somewhat weaker relationship between PTSD severity and pain in the highly religious (B = 0.03, SE =0.01, t = 2.28, p = 0.02) compared to those who were not (B = 0.06, SE =0.01, t = 6.55, p < 0.0001). Likewise, effects of pain on PTSD symptoms appeared weaker in the highly religious (B = 0.67, SE =0.37, t = 1.80, p = 0.07) compared to others (B = 1.32, SE =0.25, t = 5.34, p < 0.0001).Conclusion: This study provides only minimal evidence that high religious involvement may buffer the effects of PTSD symptoms on pain and vice-versa.

AAPT Diagnostic Criteria for Peripheral Neuropathic Pain: Focal and Segmental Disorders

Peripheral neuropathic pain is among the most prevalent types of neuropathic pain. No comprehensive peripheral neuropathic pain classification system that incorporates contemporary clinical, diagnostic, biological, and psychological information exists. To address this need, this article covers the taxonomy for 4 focal or segmental peripheral neuropathic pain disorders, as part of the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership and the American Pain Society (APS) collaborative to develop a standardized, evidence-based taxonomy initiative: the ACTTION-APS Pain Taxonomy (AAPT). The disorders—postherpetic neuralgia, persistent posttraumatic neuropathic pain, complex regional pain disorder, and trigeminal neuralgia—were selected because of their clinical and clinical research relevance. The multidimensional features of the taxonomy are suitable for clinical trials and can also facilitate hypothesis-driven case-control and cohort epidemiologic studies. PerspectiveThe AAPT peripheral neuropathic pain taxonomy subdivides the peripheral neuropathic pain disorders into those that are generalized and symmetric and those that are focal or segmental and asymmetric. In this article, we cover the focal and segmental disorders: postherpetic neuralgia, persistent posttraumatic neuropathic pain, complex regional pain disorder, and trigeminal neuralgia. The taxonomy is evidence-based and multidimensional, with the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.

Injection of ropivacaine combined with pregabalin in a patient with post-traumatic trigeminal neuropathic pain

Introduction: Post-traumatic painful trigeminal neuropathy is a chronic facial pain secondary to trigeminal nerve injury. The treatment of this pain is a therapeutic issue due to the alteration of quality of life that it generates. Observation: A 58-year-old man whose main history of facial trauma has been consulted in the Odontology Department for bilateral trigeminal neuropathic pain that has been evolving for several months. The interrogation revealed continuous pain like electric shocks in the canine areas and daily painful exacerbations. Hyperesthesia and allodynia were found on clinical examination. The patient had received several treatments, oral and local, without significant improvement. As a last resort, injections of ropivacaine every 2 weeks associated with pregabalin (200 mg/day) were performed. At 6 months, there was a clear decrease in the burning sensation and a complete disappearance of painful exacerbations. Discussion: Two studies have recently shown the benefit of the combination of an antiepileptic and a local analgesic in the treatment of classical trigeminal neuralgia, justifying their use in a context of post-traumatic neuropathic pain. Conclusion: Further studies with higher levels of evidence are needed to confirm these preliminary results.

Clinical Features Contributing to Cortical Thickness Changes in Chronic Migraine - A Pilot Study.

The objectives of this cross-sectional pilot study were threefold: to identify regions of cortical thickness that differentiate chronic migraine (CM) from controls, to assess group differences in interregional cortical thickness covariance, and to determine group differences in associations between clinical variables and cortical thickness. Cortical thickness alterations in relation to clinical features have not been adequately explored in CM. Assessment of this relationship can be useful to describe cortical substrates for disease progression in migraine and to identify clinical variables that warrant management emphasis. Thirty CM cases (mean age 40 years; male-to-female 1:4) and 30 sex-matched healthy controls (mean age 40 years) were enrolled. Participants completed self-administered and standardized questionnaires assessing headache-related clinical features and common psychological comorbidities. T1-weighted brain images were acquired on a 3T MRI. A whole-brain cortical thickness analysis was performed. Additionally, correlations between all brain regions were assessed to examine interregional cortical thickness covariance. Interactions were analyzed to identify clinical variables that were significantly associated with cortical thickness. The whole brain cortical thickness analysis revealed no significant differences between CM patients and controls. However, significant associations between clinical features and cortical thickness were observed for the patients only. These associations included the right superior temporal sulcus (R2 =0.72, P=.001) and the right insula (R2 =0.71, P=.002) with distinct clinical variables ie, longer history of CM, posttraumatic stress disorder (PTSD), sleep quality, pain self-efficacy, and somatic symptoms. Higher interregional cortical covariance was found in CM compared to controls (OR=3.1, CI 2.10-4.56, P<.0001), such that cortical thickness between regions tended to be more correlated in patients, particularly in the temporal and frontal lobes. CM patients have significantly greater cortical covariance compared to controls. Cortical thickness in CM patients was predominantly accounted for by CM duration, PTSD, and poor sleep quality, while improved pain self-efficacy buffered cortical thickness. While it is important to address all CM features and comorbidities, it may be useful to emphasize optimizing the management of certain clinical features that contribute to cortical abnormalities including managing PTSD, early management to shorten duration of CM, and improving pain self-efficacy and sleep quality.

THE ROLE OF THE GENERAL SURGEON IN THE MANAGEMENT OF PATIENT WITH MALIGNANT MELANOMA

Malignant melanoma is now a major public health problem. Annually, in the European Union about 10 cases of malignant melanoma occur per 100,000 inhabitants. Every 57 minutes, worldwide, a person dies due to the existence of a malignant melanoma. I report the case of a woman, C.V., aged 49, who comes to the emergency room of the University Emergency Hospital of Bucharest, for a posttraumatic abdominal pain syndrome (abdominal contusion caused by a traffic accident 5 days earlier); the thorough clinical examination performed in order to assess the posttraumatic lesions reveals no injury marks, and the paraclinical evaluations reveal no visceral injuries. During the clinical examination, the medical team on call identifies a dark brown pigmented tumor with a diameter of about 1 cm on the posterior face of the lower third of the left leg, which raises the suspicion of malignancy. The patient is referred to a dermatology department. The corroboration of the dermatological clinical examination with the specific paraclinical investigations led to the decision to perform the surgical excision of the pigmented tumoral formation with the repair of the defect with a skin graft. The histopathological examination of the resected piece confirms the diagnosis of malignant extensive superficial melanoma. The patient returned to the department of general surgery with the indication for a surgical evaluation. The present paper attempts to answer the question: „What is the role of the general surgeon in the management of patients with malignant melanoma?” In the case of the presented patient, the role of the general surgeon was a complex one, with major prognostic implications.

PTSD Symptoms and Acute Pain in the Emergency Department: The Roles of Vulnerability and Resilience Factors Among Low-income, Inner-city Women.

Given high levels of traumatic stress for low-income, inner-city women, investigating the link between posttraumatic stress disorder (PTSD) and pain is especially important. Using the conservation of resources theory, we investigated direct and indirect relationships of PTSD symptoms, vulnerability factors (ie, resource loss, depressive symptoms, and social undermining), and resilience factors (ie, optimism, engagement, and social support) to acute pain reports in a sample of low-income, inner-city women. Participants (N=341; mean age=28 y; 58.0% African American) were recruited from an inner-city Emergency Department following presentation with acute pain. Study data were gathered from psychosocial questionnaires completed at a baseline interview. Structural equation modeling examined direct and indirect relationships among PTSD symptoms, vulnerability factors, and resilience factors on self-reported pain intensity and pain interference. PTSD symptoms were directly related to higher pain intensity and pain interference and indirectly related through positive associations with vulnerability factors (all Ps<0.05). Pathways through resilience factors were not supported. Results suggest that presence of PTSD symptoms is associated with elevated acute pain responses both indirectly via psychosocial vulnerability factors and directly, independent of the psychosocial factors assessed. Resilience factors did not play a significant role in determining acute pain responses. Consistent with conservation of resources theory, the negative effects of vulnerability factors outweighed the positive effects of resilience factors.

INCIDENCIA DE COLONIZACIÓN BACTERIANA E INFECCIONES EN CATÉTERES Y SISTEMAS DE INFUSIÓN EPIDURALES PARA EL MANEJO DEL DOLOR AGUDO EN EL HOSPITAL SANTO TOMÁS DE OCTUBRE 2016 A MARZO 2017.

La analgesia epidural es un procedimiento mínimamente invasivo, que en ocasiones puede estar asociado a complicaciones como colonización e infección asociada al uso del catéter en el canal vertebral y áreas contiguas. Nuestro objetivo es determinar la incidencia de colonización e infección bacteriana de catéteres y sistemas de infusión epidural, colocados para el manejo del dolor agudo posoperatorio y postraumático, así como también los factores que estarían relacionados con el desarrollo de infecciones. Un estudio prospectivo observacional fue llevado a cabo en 54 pacientes a los cuales se colocó catéter epidural por un periodo igual o mayor a 48 horas. Al momento de remoción del catéter se enviaron muestras para cultivo de: la superficie de la piel circundante del catéter, punta de catéter y solución analgésica. Los cultivos de punta de catéter fueron positivos en 7 casos (13% de colonización) y en 16 casos (29.6% de infección).De los infectados, en el 37% hubo crecimiento de Acinetobacter baumanni con mayor frecuencia; 1 caso (1.9%) de soluciones analgésicas reportó crecimiento de Staphylococcus epidermidis. Se realizó análisis para el cálculo del riesgo asociado (Oddsrattio), para infección bacteriana de punta de catéter, comparándose el sitio hospitalario de colocación, dentro y fuera del salón de operaciones, encontrando que este último es un factor protector Oddsrattio= 0.19 IC (0.04-0.92). Concluimos que la incidencia de colonización bacteriana fue del 13%. Las variables que más impactaron fueron: la colocación de catéteres dentro del salón de operaciones, la menor cantidad de intentos y experiencia del operador para disminuir las infecciones de los dispositivos estudiados.

Magnetic resonance imaging of ankle ligaments: A pictorial essay.

Ankle trauma is commonly encountered and is most often a sprain injury affecting the ligaments. Accurate diagnosis and appropriate treatment rest on knowledge of complex ligamentous anatomy of ankle and the entire spectrum of pathologies. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosing ligament pathologies because of its multiplanar capability and high soft tissue contrast. With MRI, it is possible to triage and attribute the cause of post traumatic ankle pain to bone, ligament, or tendon pathologies, which otherwise overlap clinically. In this pictorial essay, emphasis is given to the intricate and unique anatomy and orientation of ankle ligaments. Pathologies of ankle ligaments have been elaborated.

Reliability of anterior medial collateral ligament plication of the elbow

The aim of this study is to describe a new surgical procedure to plicate the anterior bundle medial collateral ligament (aMCL) into its humeral footprint using a suture anchor, and to present the results of a preliminary clinical series. Eight patients with posttraumatic medial elbow pain and signs of medial elbow instability underwent aMCL plication with suture anchors and decompression of ulnar nerve. Arthroscopic evaluation permitted to define signs of minor medial elbow instability; 70°-scope was used to document from an intra-articular point of view of the aMCL status. The patients were then retrospectively evaluated with the Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPI) and single-assessment numeric evaluation (SANE) by an independent examiner. In all cases, the 70°-scope allowed direct visualization of the aMCL. Lateral subluxation of the coronoid process into the trochlea was observed in all patients. Postoperative median SANE was 50 [35-74.5] points; postoperative median OES was 17 [15.5-31.5] points; postoperative median MEPI was 65 [57.5-72.5] points. None of the patients reported further episodes of medial elbow instability or pain and all patients returned to normal daily activities. The 70°-scope arthroscopic evaluation of the joint allows a direct evaluation of the inner aMCL status. Lateral subluxation of the coronoid process into the trochlea was observed and can be considered a sign of minor medial elbow instability. Mini-open suture anchor aMCL plication is an original technique that enables an anatomic and minimally invasive ligament retension. The authors introduce a valid and safe treatment of posttraumatic medial elbow laxity.

Efficacy of pregabalin in post-traumatic peripheral neuropathic pain: a randomized, double-blind, placebo-controlled phase 3 trial

The growing need for symptomatic treatment of post-traumatic neuropathic pain (PTNP) continues to be unmet. Studies evaluating the efficacy of pregabalin for reducing neuropathic pain following trauma and surgery yielded positive results over ≤ 8-week treatment. To assess the efficacy and tolerability of pregabalin over 3 months in patients with PTNP, a randomized, double-blind, placebo-controlled, parallel-group trial evaluated patients with PTNP at 101 centers in 11 countries—the longest, largest such trial. Adults diagnosed with PTNP were randomly assigned (1:1) to 15 weeks of pregabalin (flexibly dosed 150–600 mg/day) or matching placebo. Primary efficacy analysis was by mixed-model repeated measures comparing change from baseline to week 15 in weekly mean pain scores between active and placebo groups. Evaluable patients included 274 in the pregabalin group and 265 in the placebo group. Trauma was surgical in 49.6% of patients, non-surgical in the remainder. The primary efficacy analysis showed no statistically significant difference between pregabalin and placebo groups in the change from baseline to week 15 [mean difference, − 0.22 points (95% confidence interval, 0.54–0.10); p = 0.1823]. However, comparisons for key secondary outcome measures yielded p values < 0.05 favoring pregabalin. Consistent with the known safety profile of pregabalin, the most common adverse events were dizziness and somnolence (14.6 and 9.9% of patients, respectively) with pregabalin (vs 4.2 and 3.4% with placebo). These findings demonstrate the feasibility of conducting a large, phase 3 registration trial in the heterogeneous PTNP study population.ClinicalTrials.gov NCT01701362.

Elbow arthroscopy in children and adolescents: analysis of outcome and complications

BackgroundChondral or osteochondral lesions, post-traumatic contracture and loose bodies of the elbow are often associated with chronic pain, stiffness, repetitive swelling and joint blockages. Therefore, arthroscopy of the elbow is often used in the elderly for the treatment of osteochondral defects or arthrolysis. There are only a few reports and studies about arthroscopic therapy of the elbow in children and adolescents. This study assesses the clinical outcome of arthroscopic therapy in this age group.MethodsIn a retrospective study, children and adolescents who underwent an elbow arthroscopy in the period from 2010 to 2014 were included. The children were evaluated using the validated outcome measures Mayo Elbow Performance Score (MEPS), range of motion, pain on visual analog scale (VAS), Oxford Elbow Score (OES), quick dash and postoperative satisfaction. Furthermore, all complications were analyzed.ResultsIn total, 27 patients were included. The mean (range) age was 14 (11–17) years, with a follow-up of 45 months. Fourteen (52%) were female and thirteen children (48%) were male. Twenty children had an arthroscopy due to osteochondritis dissecans and seven children for post-traumatic pain and stiffness. The mean (standard deviation) MEPS improved from 65 (15) to 96 (8; p = .005). The OES and quick dash were 93 and 5.4. The mean extension improved from − 15° (± 13.8) to 3° (± 10.2; p < .001). The mean flexion improved from 131° (± 13.4) to 137° (± 9.5; p = .003). Average pain on VAS was postoperative .2 (± .5), and 81.5% of all children had excellent or good results. There were no complications such as damage of nerves or blood vessels observed.ConclusionElbow arthroscopy is an appropriate and safe treatment option in children and adolescents with good and excellent postoperative results.

Missed fractures of the greater tuberosity

BackgroundFractures of the greater tuberosity may result from a variety of mechanisms. Missed injury remains a persistent problem, both from a clinical and medico-legal point-of-view. Few studies on this topic are available in the literature. We present the clinical and radiological findings of a consecutive series of 17 patients who were diagnosed and managed with undisplaced greater tuberosity fractures.MethodsA retrospective study of a consecutive series of 17 patients who sustained an occult greater tuberosity fracture were performed. Patients sustained a traumatic occult greater tuberosity fracture, underwent shoulder radiographs after trauma in 5 days and they were diagnosed as negative by a consultant radiologist. All patients received a standard assessment using MRI (Magnetic Resonance Imaging) scans Each patient was evaluated for arm dominance, trauma history, duration and type of symptoms and post-treatment Oxford Shoulder Score.ResultsAt the final follow up the mean OSS (Oxford Shoulder Score) was 38.3 (range 17–46; SD 9.11). Three patients required a glenohumeral joint injection for post-traumatic pain and stiffness and three patients required subacromial decompression for post-traumatic impingement.ConclusionsThough undisplaced greater tuberosity fracture can be managed non-operatively with good results, patients with persistent post-traumatic shoulder pain, tenderness and limitation of shoulder function warrant investigation with MRI to identify occult fractures. Prompt identification of these fractures can facilitate patient treatment and counselling, avoiding a source of patient dissatisfaction and litigation.

Blood Stasis Therapy for Traumatic Injury: A Prospective, Single-Arm, Pre-Post Pilot Study.

Blood stasis is an important pathophysiologic concept in Traditional East Asian Medicine. It has been considered to be a pathogenic factor in chronic and incurable conditions such as pain, infertility, cancer, coronary heart disease, and others. The aim of this study was to investigate the effects of pain reduction by blood stasis treatment for blood stasis syndromes with traumatic injury. A single-center prospective pretest-post-test pilot study included 73 patients with a trauma that occurred within the past 2 weeks who were admitted into Jaseng Hospital of Korean Medicine from August 2015 through December 2015. Of the 50 patients analyzed in this study, 42 were women (mean age, 33.52). Triple Energizer-reinforcing Saam acupuncture set, herbal medicine (Dangkwisoo-san), and wet cupping on tender point, which are Korean medical therapies generally executed to treat post-traumatic pain, were performed. The patients had to receive at least six sessions of treatment during the 2 weeks, with subsequent treatment being performed within 3 ± 1 days after the previous treatment. Numeric rating scale (NRS) score and general pain severity indicator was measured as a primary outcome measure. The blood stasis questionnaire, oximetry, and patient's satisfaction were also measured. The mean size of subcutaneous bleeding (width and length) and NRS score as a general pain indicator significantly decreased over the visits (all p < 0.01, visit 1 vs. visit 6). Among the blood stasis symptoms in the questionnaire, 11 blood stasis indicators significantly decreased (all p < 0.05). The patients showed significant improvement in the minimum and maximum value of peripheral perfusion index after the treatment (p = 0.011 and p = 0.15, respectively). This study reveals that blood stasis treatment may help improve the pain of patients with traumatic injury by enhancing the peripheral blood flow. The significant results observed in this study support some evidence of the theories of diagnosing blood stasis pattern and treatments of that pattern in Korean Medicine.

A Functional riboSNitch in the 3' Untranslated Region of FKBP5 Alters MicroRNA-320a Binding Efficiency and Mediates Vulnerability to Chronic Post-Traumatic Pain.

Previous studies have shown that common variants of the gene coding for FK506-binding protein 51 (FKBP5), a critical regulator of glucocorticoid sensitivity, affect vulnerability to stress-related disorders. In a previous report, FKBP5 rs1360780 was identified as a functional variant because of its effect on gene methylation. Here we report evidence for a novel functional FKBP5 allele, rs3800373. This study assessed the association between rs3800373 and post-traumatic chronic pain in 1607 women and men from two ethnically diverse human cohorts. The molecular mechanism through which rs3800373 affects adverse outcomes was established via in silico, in vivo, and in vitro analyses. The rs3800373 minor allele predicted worse adverse outcomes after trauma exposure, such that individuals with the minor (risk) allele developed more severe post-traumatic chronic musculoskeletal pain. Among these individuals, peritraumatic circulating FKBP5 expression levels increased as cortisol and glucocorticoid receptor (NR3C1) mRNA levels increased, consistent with increased glucocorticoid resistance. Bioinformatic, in vitro, and mutational analyses indicate that the rs3800373 minor allele reduces the binding of a stress- and pain-associated microRNA, miR-320a, to FKBP5 via altering the FKBP5 mRNA 3'UTR secondary structure (i.e., is a riboSNitch). This results in relatively greater FKBP5 translation, unchecked by miR-320a. Overall, these results identify an important gene-miRNA interaction influencing chronic pain risk in vulnerable individuals and suggest that exogenous methods to achieve targeted reduction in poststress FKBP5 mRNA expression may constitute useful therapeutic strategies.SIGNIFICANCE STATEMENTFKBP5 is a critical regulator of the stress response. Previous studies have shown that dysregulation of the expression of this gene plays a role in the pathogenesis of chronic pain development as well as a number of comorbid neuropsychiatric disorders. In the current study, we identified a functional allele (rs3800373) in the 3'UTR of FKBP5 that influences vulnerability to chronic post-traumatic pain in two ethnic cohorts. Using multiple complementary experimental approaches, we show that the FKBP5 rs3800373 minor allele alters the secondary structure of FKBP5 mRNA, decreasing the binding of a stress- and pain-associated microRNA, miR-320a. This results in relatively greater FKBP5 translation, unchecked by miR-320a, increasing glucocorticoid resistance and increasing vulnerability to post-traumatic pain.

Craniofacial Trauma Is Associated With Significant Psychosocial Morbidity 1 Year Post-Injury

The face and head play critical roles in one's sense of self and body image; as such, facial, head, and scalp injuries and potential associated disfigurement can lead to particular difficulties in coping. This study examined the psychosocial outcomes of patients with craniofacial (CF) trauma 1year after injury and compared these outcomes with those of other traumatically injured patients who did not sustain such injuries. It was hypothesized that participants in the CF injury group would have worse outcomes than those without CF trauma. This prospective longitudinal study included patients at least 18years of age admitted to the trauma service of a level I trauma center for at least 24hours. Demographic and injury-related variables were collected. CF injury was determined by International Classification of Diseases, Ninth Revision codes. Outcomes were measured at baseline and at 12months and included depression, post-traumatic stress disorder (PTSD), alcohol use, and pain severity. Paired t tests and logistic regression were used for analysis. Fifteen percent (n=35) of the study sample (N=230) had CF injuries. Those with CF injuries had lower income, higher injury severity, and higher intensive care unit admission rates. The CF andnon-CF trauma groups did not differ in rates of depression or PTSD at either time point. However, participants with CF trauma had higher odds of risky alcohol use than those without CF trauma at baseline and lower odds of a higher pain severity score at baseline and 12months. The groups did not differ in depression and PTSD. However, rates of depression, PTSD, alcohol use, and physical pain were higher than expected for the 2 groups. Given the high rate of psychological morbidity found after CF trauma, patients with these injuries should be screened for symptoms soon after injury and provided with resources for treatment.

Do post-traumatic pain and post-traumatic stress symptomatology mutually maintain each other? A systematic review of cross-lagged studies.

After traumatic exposure, individuals are at risk of developing symptoms of both pain and post-traumatic stress disorder (PTSD). Theory and research suggest a complex and potentially mutually maintaining relationship between these symptomatologies. However, findings are inconsistent and the applied methods are not always well suited for testing mutual maintenance. Cross-lagged designs can provide valuable insights into such temporal associations, but there is a need for a systematic review to assist clinicians and researchers in understanding the nature of the relationship. Thus, the aim of this systematic review was to identify, critically appraise, and synthesize results from cross-lagged studies on pain and PTSD symptomatology to assess the evidence for longitudinal reciprocity and potential mediators. Systematic searches resulted in 7 eligible studies that were deemed of acceptable quality with moderate risk of bias using the cohort study checklist from Scottish Intercollegiate Guidelines Network. Furthermore, synthesis of significant pathways in the cross-lagged models showed inconsistent evidence of both bidirectional and unidirectional interaction patterns between pain and PTSD symptomatology across time, hence not uniformly supporting the theoretical framework of mutual maintenance. In addition, the synthesis suggested that hyperarousal and intrusion symptoms may be of particular importance in these cross-lagged relationships, while there was inconclusive evidence of catastrophizing as a mediator. In conclusion, the findings suggest an entangled, but not necessarily mutually maintaining relationship between pain and PTSD symptomatology. However, major variations in findings and methodologies complicated synthesis, prompting careful interpretation and heightening the likelihood that future high-quality studies will change these conclusions.

규칙적 운동, 신체적 자기-효능감, 외상후 성장, 외상후 시간경과와 주관적 외상고통간의 관계

본 연구의 목적은 첫째 시간경과와 신체적 자기-효능감 → 외상후 성장 → 주관적 외상고통간의 인과모형을 검증하고. 둘째, 이 인과모형에서 규칙적 운동과 무운동 집단의 영향력에 차이를 알아보는 데 있다. 이를 위해 운동 동호회 회원들과 00대학교에 운동과 건강 수업을 수강하는 대학생 총 342명(규칙적 운동 236명, 무운동 106명)이 신체적 자기효능감, 외상후 성장, 주관적 외상고통 설문지에 응답하였다. 응답된 자료는 SPSS WIN 21.0를 이용하여 기술통계(descriptive statistics)분석, t-검증(t-test), 요인분석, Cronbach‘s α 분석으로 처리되었으며, AMOS 18.0을 이용하여 경로분석으로 처리되었다. 또한 운동집단과 무운동집단의 경로계수를 비교하기 위해 쌍별모수비교(Pairwise Parameter Comparisons) 분석을 실시하였다. 그 결과 첫째, 신체적 자기-효능감은 외상후 성장에 긍정적 영향을 미쳤으며, 외상후 성장은 외상후 주관적 외상고통을 감소시키는 것으로 나타났다. 둘째, 규칙적 운동집단이 무운동집단에 비해 외상후 성장 → 주관적 외상고통의 경로 값이 더 큰 것으로 나타났다. 셋째, 시간경과 → 외상후 성장과 주관적 외상고통의 경로값 또한 규칙적 운동집단이 무운동집단에 비해 더 큰 것으로 나타났다. 이러한 결과는 규칙적 운동과 신체적 자기-효능감이 외상후 성장을 증진시키고, 외상후 주관적 외상고통을 감소시키는 데 효과적이라는 것을 의미한다. 이에 규칙적 운동과 신체적 자기-효능감이 외상후 성장을 증진시킬 수 있는 심리학적 기전에 대해 논의 되었다.

Is there an association between psychological factors and developing complex regional pain syndrome after an ankle fracture?

Background: The purpose of this study was to evaluate the association between psychological dysfunction and developing complex regional pain syndrome (CRPS) after an ankle fracture. Methods: The PearlDiver database was used to identify patients who sustained an ankle fracture and developed CRPS based on the presence or absence of psychological disorders. Results: Results of the database identified 163,529 patients who sustained an ankle fracture, and CRPS was identified in 10,127 (6.2%) of these patients. The risk of developing CRPS after an ankle fracture was significantly elevated, with an odds ratio (OR) of 5.44 (P&lt;0.0001) in patients with a psychological disorder. There was no additional risk (OR 0.98, P=0.31) for developing CRPS in patients with a psychological disorder who underwent operative management. Conclusions: In patients with known psychological comorbidities who sustain an ankle fracture and have atypical posttraumatic pain, there should be elevated suspicion for CRPS.

The value of multi-detector CT arthrography of the wrist joint in evaluation of ligamentous and capsular injuries in post-traumatic pain

The wrist joint is a complex joint containing several intrinsic and extrinsic ligaments that contribute to carpal stability. There is increased incidence of ligamentous/capsular injury following trauma. ObjectiveThe aim of this study was to assess the value of high resolution MDCT arthrography in detection of various ligamentous and capsular injuries of the wrist in post-traumatic writ pain. Patients and methodsFrom August 2016 to February 2017 Seventeen patients with posttraumatic wrist pain underwent MDCT arthrography primarily through radiocarpal injection and using high resolution study, all patients have negative MRI study of the wrist. Results59% of cases had ligamentous/capsular tear. The most frequent was the capsular tears. Incomplete intrinsic ligament tears were observed, the dorsal scaphotrapezio-trapezoid ligament was the commonest to be affected. Class IA traumatic TFC tear was found in 12%. There was significant high positive correlation between the VAS score for wrist pain and the presence of ligamentous/capsular tear in absence of bone fracture. ConclusionMDCT arthrography of the wrist is an excellent imaging method that can detect MRI occult ligamentous tear in unexplained post traumatic pain.

F18. Do Fear of Movement and Negative Cognitions After Trauma Lead to Activity Avoidance, Depression, and Chronic Posttraumatic Pain Development? Testing the Fear-Avoidance Model Using a Large Prospective Cohort

F18. Do Fear of Movement and Negative Cognitions After Trauma Lead to Activity Avoidance, Depression, and Chronic Posttraumatic Pain Development? Testing the Fear-Avoidance Model Using a Large Prospective Cohort