Background. There are no published studies investigating predictive values of psychological distress on effectiveness of epidural injection. Aims. To evaluate response to epidural injection (EI) in patients with chronic lower back pain (CLBP) with and without psychological distress. Methods. 96 patients with CLBP were recruited to this prospective cohort study. They had preoperative level of distress measured using Modified Zung Index (MZI) and Modified Somatic Perception Questionnaire (MSPQ); pain with Visual Analogue Score (VAS) and McGill Pain Questionnaire (MPQ); back related disability with Oswestry Disability Index (ODI). Fluoroscopic caudal EI comprising 80 mg methylprednisolone and 8 mg of lignocaine was performed. Scores were repeated at 6, 12, and 26 weeks. Successful outcome was Minimal Clinically Important Change (MCIC) in any given measure. Results. There were 62.5% not-distressed patients, 3.1% somatising, 15.6% depressed and 18.8% with mixed distress. Preoperative VAS was 82.4, MPQ 18.2 and ODI 51.6. Distress was associated with worse MPQ and ODI. Average VAS and MPQ improved significantly at 6 and 26 weeks. Mean change of ODI was significant but less than MCIC. Average magnitude of change of VAS and ODI did not differ between distressed and not-distressed. MPQ improved significantly more in the distressed. MZI was significant predictor of VAS-MCIC at 6 weeks while MZI and MSPQ at 6 months. None could predict this outcome independently. MSPQ was the only individual predictor of MPQ-MCIC at any time; MSPQ≥8 could predict MPQ-MCIC with 53%-sensitivity and 78%-specificity. MZI was significant predictor of ODI-MCIC but not individually.88% patients were satisfied with the treatment at 6 weeks and 63% at 6 months (significantly higher rate if somatising). Conclusions. Early psychological screen was correlated with outcome following epidural injection in CLBP and capable of predicting some response to treatment. Minimal, short-lived improvement of distress was not related to post-treatment CLBP measures

Introduction. Preoperative psychological distress has been reported to predict poor outcome and patient dissatisfaction after total hip replacement (THR). We investigated this relationship in a prospective multi-centre study between January 1999 and January 2002. Methods. We recorded the Oxford Hip Score (OHS) and SF36 score preoperatively and up to five years after surgery and a global satisfaction questionnaire at five year follow up for 1039 patients. We dichotomised the patients into the mentally distressed (Mental Health Scale score - MHS <50) and the not mentally distressed (MHS (50) groups based on their pre-operative MHS of the SF36. 776 (677 not distressed and 99 distressed) out of 1039 patients were followed up at 5 years. Results. Both pre and post-operative OHS and SF-36 scores were significantly worse in the distressed group (both p<0.001). However, both groups experienced statistically significant improvement in OHS and MHS, which was maximal at 1 year after surgery and was maintained over the follow up. The trend in OHS gain was similar in both groups. There was a substantial improvement in mental distress in patients who reported mental distress prior to surgery. The mentally distressed group also reported better mental health gain compared to the non-distressed group. There was no significant difference in patient satisfaction or willingness to have the surgery again at 5 years following surgery between the two groups. Conclusion. Despite having worse absolute values both pre and post operatively, patients with mental distress did not have any less functional gain from THR

This study explored psychological functioning and coping styles in adult patients with localized and metastatic extremity soft-tissue sarcoma (STS) from diagnosis through survivorship in a single expert sarcoma center in Canada. Our analyses were driven by three main goals: 1) to develop a better understanding of the affective responses and coping mechanisms in patients who face this rare illness, 2) to identify areas of psychological functioning in which patients with STS experience most difficulties, and 3) to describe how these areas could be best addressed in clinical settings. This descriptive qualitative study is a part of a larger mixed-methods study on health related quality of life (HRQoL) in adult patients with soft-tissue sarcoma treated between 2003 and 2018. Purposive sampling based on demographic and disease variables from all patients within a prospective database was utilized to ensure a representative patient population. Three formats of data collection were conducted in French and English, 2 online focus groups (total n=12), 2 in-person focus groups (total n=12), as well as individual semi-structured interviews (n=4). Data was analyzed using inductive thematic networks approach using the qualitative software N-Vivo 12. Codes were generated by 2 independent qualitative experts that captured key concepts referring to psychological functioning and coping mechanisms. Basic themes were clustered into organizing themes, which were later merged into a global theme. Attention was paid to deviant cases, and within-group dynamics during focus group discussion analysis. Any discrepancies or inconsistencies in coding were resolved in a consensus meeting. The final sample size was determined when data saturation was reached, and no new themes emerged. Our analyses of psychological well-being and functioning revealed three main themes, mood, anxiety, and body image concerns. Feelings of depression and low mood were prominent, coinciding with physical symptoms and limitations especially during the phase of treatment and recovery. Women were more likely to report emotional volatility, while men tended to report more preoccupation. Loss of control and independence, anxiety related to illness recurrence, uncertainty about the future and facing one's mortality significantly impacted quality of life. Furthermore, while patients were more concerned with limb functionality, disfigurement and self-consciousness featured prominently in the narrative. Four adaptive coping styles were observed, positive reframing and optimism, finding a purpose, being proactive, and using humor. Among the maladaptive strategies, we noted passive acceptance, and avoidance and denial. Psychological well-being is an important domain in the HRQoL of adult patients with extremity STS. Physicians and medical workers should encourage adaptive coping mechanisms such as positive reframing and optimism. Patients endorsing higher levels of psychological distress and maladaptive coping styles should be monitored for their well-being and multidisciplinary strategies employed to optimize psychological function and HRQoL

Introduction. Pain related to knee osteoarthritis (OA) is a complex phenomenon that cannot be fully explained by radiographic disease severity. We hypothesized that pain phenotypes are likely to be derived from a confluence of factors across multiple domains: knee OA pathology, psychology, and neurophysiological pain processing. The purpose of this study was to identify distinct phenotypes of knee OA, using measures from the proposed domains. Methods. Data from 3494 subjects participating in the Osteoarthritis Initiative (OAI) study was analyzed. Variables analyzed included: radiographic OA severity (Kellgren-Lawrence grade), isometric quadriceps strength, Body Mass Index (BMI), comorbidities, CES-D Depression subscale score, Coping Strategies Questionnaire Catastrophizing subscale score, number of pain sites, and knee tenderness on physical examination. Variables used for comparison across classes included pain severity, WOMAC disability score, sex and age. Latent Class Analysis was performed. Model solutions were evaluated using the Bayesian Information Criterion. One-way ANOVAs and post hoc least significance difference tests were used for comparison of classes. Results. A four-class model was identified. Class 1 (57% of study population) had lesser radiographic OA, little psychological involvement, greater strength, and less pain sensitivity. Class 2 (28%) had higher rates of knee joint tenderness. Class 3 (10%) had greater psychological distress and more bodily pain sites. Class 4 (4%) had more comorbidities. Additionally, Class 1 was the youngest, had the lowest disability, and least pain. Class 4 was the oldest. Class 2 had a higher proportion of females. Class 3 had the worst disability and most pain. Conclusions. Four distinct pain phenotypes for knee OA were identified. Psychological factors, knee tenderness, and comorbidities appear to be important in defining phenotypes of OA-related pain. Therapies in knee OA should take a multicomponent approach, recognizing the factors most relevant to an individual's experience of pain

Background. Several orthopaedic studies have found significant correlation between pre-operative psychological status and post-operative outcomes. The majority of research has focused on patients requiring lower limb and spine surgery. Few studies have investigated the effect of psychological status on the outcome of upper limb operations. We prospectively investigated the association between pre-operative psychological status and early postoperative shoulder pain and function in patients requiring arthroscopic subacromial decompression (ASAD) for impingement syndrome. Methods. A consecutive series of patients in 2009/10 completed questionnaires 2 weeks pre-operatively and 3 and 6 weeks post-operatively that assessed psychological state, shoulder function and pain. The hospital anxiety and depression scale, the Oxford shoulder score and a pain visual analogue scale assessed psychological status, shoulder function and shoulder pain, respectively. Data was analysed using non-parametric statistical methods. Results. Thirty-one patients participated (21 women; 10 men; mean age 54.6 years; age range 21–89 years). Preoperative anxiety was significantly associated with pre-operative shoulder pain (P < 0.05). Pre-operative psychological status did not correlate with post-operative shoulder pain or function. Greater pre-operative anxiety and depression were significantly associated with post-operative psychological distress (P < 0.05). Overall shoulder pain, function and psychological state improved significantly during the study (P < 0.05) regardless of pre-operative psychological status. Conclusion. Despite pre-operative associations between anxiety and shoulder pain, there were no associations between pre-operative psychological status and post-operative outcomes. Our results from a total of 31 patients suggest there is no justification for routinely assessing psychological status in patients with ‘uncomplicated’ impingement syndromes that require ASAD. The majority of patients benefit from ASAD both physically and psychologically regardless of psychological state. Therefore abnormal pre-operative psychological status should not be a justifiable reason for delaying or denying this effective operation

Introduction. This study investigates the effect of somatisation on results of lumbar surgery. Methods. Pre- and post-operative data of all primary discectomies and posterior lumbar decompressions were prospectively collected. Pain using the Visual Analogue Score (VAS) and disability using the Oswestry Disability Index (ODI) were measured. Psychological assessment used the Distress Risk Assessment Method (DRAM). Follow-up was at 1 year. Results. There were a total of 320 patients (average age 49.7 years). Pre-operatively there were 61 Somatising and 75 psychologically Normal patients. 47 of the pre-operative Somatisers were available for follow-up. All pre-operative parameters were significantly higher compared with the Normal group (back pain VAS 6.3 and 3.8; leg pain VAS 7 and 4.7; ODI 61 and 34.4 respectively). At 1 year follow-up, 23% of the somatising patients became psychologically Normal; 36% became At Risk; 11% became Distressed Depressed; and 30% remained Distressed Somatisers. The post-operative VAS for back and leg pain of the 11 patients who had become psychologically Normal was 3.4 (pre-op 6.8) and 3.2 (pre-op 6.6) respectively. In the 14 patients who remained Distressed Somatisers the corresponding figures were 5.6 (pre-op 7.8) and 6.7 (pre-op 7.0). The post-operative ODI of the 11 patients who had become psychologically Normal was 26.4 (pre-op 55.5). In the 14 patients who remained Distressed Somatisers the corresponding figures were 56.7 (pre-op 61.7). These differences are statistically significant. Discussion. Patients with features of somatisation are severely functionally impaired pre-operatively. One year following lumbar spine surgery, 60% (28) had improved psychologically, 23% (11) were defined as psychologically normal. This was associated with a significant improvement in function and back and leg pain. The 14 (30%) patients who did not improve psychologically and remained somatisers had a poor functional outcome. Our results demonstrate that psychological distress is not an absolute contraindication to lumbar spinal decompressive surgery

Aims

Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites.

Aims

The increase in prescription opioid misuse and dependence is now a public health crisis in the UK. It is recognized as a whole-person problem that involves both the medical and the psychosocial needs of patients. Analyzing aspects of pathophysiology, emotional health, and social wellbeing associated with persistent opioid use after injury may inform safe and effective alleviation of pain while minimizing risk of misuse or dependence. Our objectives were to investigate patient factors associated with opioid use two to four weeks and six to nine months after an upper limb fracture.

Aims

Bone demonstrates good healing capacity, with a variety of strategies being utilized to enhance this healing. One potential strategy that has been suggested is the use of stem cells to accelerate healing.