Pain intensity and symptoms of depression are correlated and individually associated with decreased physical function. We compared two explanatory mediation models: one with depression as the mediator of the association of pain intensity with physical function and the other one with pain intensity as the mediator of the effect of depression on physical function. We determined that pain intensity and symptoms of depression were partial mediators of their respective and independent effects on physical function (1). The bidirectional mediation effect suggests a reinforcement mechanism in which pain intensity and symptoms of depression reciprocally influence their negative impacts on physical function among patients with musculoskeletal illness.

Patient-reported outcome measures vary more than expected based on underlying pathology, in part due to the substantial influence of mood and coping strategies. Our study addressed the relationship between the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function score one month after hand surgery and the PROMIS Depression and PROMIS Pain Interference scores prior to surgery, accounting for other factors. Higher postoperative PROMIS Physical Function score was independently associated with lower PROMIS Pain Interference scores, lower PROMIS Depression scores, and younger age (2). Greater change in PROMIS Physical Function score was independently associated with greater PROMIS Pain Interference scores and greater time from surgery. In conclusion, mood and effective coping strategies affect the level of symptoms and limitations during recovery from hand surgery and represent important treatment opportunities for enhancing recovery.

References

1. Talaei-Khoei M, Fischerauer SF, Jha R, Ring D, Chen N, Vranceanu AM. Bidirectional mediation of depression and pain intensity on their associations with upper extremity physical function. J Behav Med. 2017 Oct 6. doi: 10.1007/s10865-017-9891-6. [Epub ahead of print] PubMed PMID: 28986704.
2. Crijns TJ, Bernstein DN, Ring D, Gonzalez RM, Wilbur D, Hammert WC. Depression and Pain Interference Correlate With Physical Function in Patients Recovering From Hand Surgery. Hand (N Y). 2018 May 1:1558944718777814. doi: 10.1177/1558944718777814. [Epub ahead of print] PubMed PMID: 29807447.