Pain intensity and activity intolerance correlate with psychosocial factors such as depression and pain interference (the degree to which pain interferes with accomplishing one’s goals) as much or more than pathophysiology in upper extremity illness. However, other factors like emotional support (perception of being cared for and valued as a person), instrumental support (perception of availability of tangible assistance when needed), positive psychosocial impact (perception and focus on the positive side of a difficult situation, sometimes characterized as post-traumatic growth, benefit-finding, or meaning-making), also might be associated with activity intolerance in patients with upper extremity orthopaedic illness. Our study found that emotional support, instrumental support and positive psychosocial illness impact are all individually associated with activity intolerance to a small degree, but pain interference has the strongest influence (1). This suggests that cognitive behavioral therapy interventions should target primarily cognitive bias in response to pain, and secondarily, aspects of social support. Treatments that encourage and enhance strategies that help patients remain active and achieve their goals despite pain seem integral to musculoskeletal health.

Individuals who experience musculoskeletal trauma may construe the experience as unjust and themselves as victims. Perceived injustice is a cognitive construct composed by negative appraisals of the severity of loss as a consequence of injury, blame, injury-related loss, and unfairness. It has been associated with worse physical and psychological outcomes in the context of chronic health conditions. The purpose of one study was to explore the association of perceived injustice to pain intensity and physical function in patients with orthopaedic trauma. Perceived injustice was associated with both activity intolerance and pain intensity in bivariate correlations, but it was not deemed as an important predictor when assessed along with other demographic and psychosocial variables in multivariable analysis (2). This study confirms prior research on the pivotal role of catastrophic thinking and self-efficacy in reports of pain intensity and activity intolerance in patients with acute traumatic musculoskeletal pain.

References

1. Nota SP, Spit SA, Oosterhoff TC, Hageman MG, Ring DC, Vranceanu AM. Is Social Support Associated With Upper Extremity Disability? Clin Orthop Relat Res. 2016 May 12. [Epub ahead of print] PubMed PMID: 27172821.
2. van Leeuwen WF, van der Vliet QM, Janssen SJ, Heng M, Ring D, Vranceanu AM. Does perceived injustice correlate with pain intensity and disability in orthopaedic trauma patients? Injury. 2016 Mar 3. pii: S0020-1383(16)30017-1. doi: 10.1016/j.injury.2016.02.018. [Epub ahead of print] PubMed PMID: 26994517.