Elsevier

The Journal of Hand Surgery

Volume 35, Issue 10, October 2010, Pages 1633-1639
The Journal of Hand Surgery

Scientific article
Relationships Among Pain Disability, Pain Intensity, Illness Intrusiveness, and Upper Extremity Disability in Patients With Traumatic Peripheral Nerve Injury

https://doi.org/10.1016/j.jhsa.2010.07.018Get rights and content

Purpose

In patients with a peripheral nerve injury, a simple conceptualization assumes that pain disability is determined by pain intensity. This study evaluated the relationships among pain intensity, illness intrusiveness, and pain disability.

Methods

After we obtained ethics board approval, we enrolled English-speaking adult patients who had experienced an upper extremity peripheral nerve injury 0.5 to 15 years previously. Patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH), Illness Intrusiveness Scale, Pain Disability Index, and McGill Pain questionnaires. We used multivariate linear regression to evaluate the variables that predicted pain disability.

Results

There were 124 patients (41 women, 83 men; mean ± SD, 41 ± 16 y of age). The median time since injury was 14 months (range, 6–145 months), and there were 43 brachial plexus nerve injuries. Mean ± SD scores were: pain disability, 29 ± 18; illness intrusiveness, 40 ± 18; DASH, 45 ± 22; and pain intensity, 4.6 ± 3.0. The pain disability, DASH, and illness intrusiveness scores were significantly higher in patients with brachial plexus injuries than in those with distal nerve injuries (p<.05). There was strong correlation between pain disability and DASH (r = 0.764, p<.001) and illness intrusiveness (r = 0.738, p<.001) and a weaker correlation with pain intensity (r = 0.549, p<.001). The final regression model predicting pain disability scores explained 70% of the variance with these predictors: DASH (β = 0.452, p<.001), illness intrusiveness (β = 0.372, p<.001), and pain intensity (β = 0.143, p=.018).

Conclusions

Pain disability was substantial after nerve injury, and pain intensity explained the least variance among the model variables. Pain intensity should be considered only one component of pain, and the impact of pain in the context of disability should be considered in patients with chronic nerve injury.

Type of study/level of evidence

Prognostic IV.

Section snippets

Materials and Methods

After we obtained approval from our institutional research ethics boards, we invited adult patients who had experienced a traumatic upper extremity peripheral nerve injury between 6 months and 15 years previously to participate in this study. Exclusion criteria were amputation injury or an upper motor neuron lesion, and the lack of ability to understand the English-language questionnaires. A total of 128 consecutive patients were invited to participate in the study when the study coordinator

Results

Table 1 presents the demographic data. There were 124 patients (83 men and 41 women) with an age of 41 ± 16 years (range, 18–80 y). Time since injury was 24 ± 27 months (median, 14 mo; range, 6–145 mo). The brachial plexus was injured in 43 cases, and the dominant arm was involved in 66 patients. Table 2 presents the scores for each outcome measure (Pain Disability Index, Illness Intrusiveness Rating Scale, DASH, and VAS pain intensity). The mean Pain Rating Index from the SF-MPQ was 13.9 ±

Discussion

In this group of patients with chronic nerve injury who had experienced trauma at least 6 months previously, there was substantial pain disability, illness intrusiveness, and upper extremity disability. In the final regression model, illness intrusiveness, upper extremity disability, and pain intensity were predictors of pain disability. After controlling for the influences of pain intensity and illness intrusiveness, upper extremity disability as measured by the DASH still accounted for a

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    This study was partially funded by a Research Grant from the American Association for Hand Surgery. C.B.N. is supported by a Canadian Institutes of Health Research (CIHR) Doctoral Fellowship Award. J.K. is supported by a CIHR Canada Research Chair in Health Psychology at York University.

    No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

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