Comorbidity of Musculoskeletal Injury Pain and PTSD
by Margaret M. Perish, MA; Rob A. Haggard, MS, LPC; Amanda Buelow; Jokae Ingram; and Robert J. Gatchel, PhD, ABPP
 Each year, the Federal Government spends an estimated $12.6 billion
on injury-related medical costs.1 In spite of advances in trauma care, people
who experience injury are often unable to return-to-work. When added to medical costs,
death and disability benefits, monies paid by insurance companies, and other private
sources, lost wages and lost productivity bring the costs of injury to $224 billion per
year.1 Orthopaedic injuries are especially problematic because they often
require prolonged treatment and frequently result in long-term disability.2,3
Studies also demonstrate a high incidence of emotional distress following such general
orthopaedic trauma4-11 and a more recent investigation indicated the incidence
of stress-related symptoms is even higher in the orthopaedic population.12 The
purpose the study by Starr and colleagues was to determine the prevalence of emotional
distress among orthopaedic trauma patients seen in clinic following injury and to examine
whether injury or demographic variables were predictive of such emotional distress. This
multi-center effort involved testing 580 orthopaedic trauma patients, with injury and
demographic information collected for all study patients. Demographic and injury data were
tested to evaluate if any were statistically associated with the presence of significant
emotional distress. Findings revealed that patients with high levels of emotional distress
had significantly higher Injury Severity Scores (p=.04), higher sum of Extremity
Abbreviated Injury Scores (p=.05), and were further out from injury than those without
high emotional distress. The study also clearly revealed that emotional distress is common
after orthopaedic trauma and led the investigators to plan further research to evaluate
whether psychological treatment can prevent high levels of such distress.
A subsequent investigation by Starr and colleagues evaluated emotional distress
associated with severe lower limb injury. Data for this study were collected as part of a
larger study, the Lower Extremity Assessment Project (LEAP), designed to compare the long
term outcomes of patients who sustained severe lower extremity trauma treated by limb
reconstruction or amputation. Patients were enrolled in LEAP during their initial
hospitalization and followed over a two-year period to assess their physical and
psychosocial health. Earlier publications of LEAP study results showed that outcomes in
many such patients were poor,2 with only approximately 50% returning to work at
two years. For the study of emotional distress, patients completed the Brief Symptom
Inventory (BSI) to assess emotional symptoms, and the Sickness Impact Profile (SIP) to
assess overall outcome. The research showed that 42% of patients screened positive for a
likely emotional disorder two years after injury, and that BSI scores were strongly
associated with SIP scores, especially SIP physical function scores. This raised the
possibility of a link between emotional outcome and functional outcome, and demonstrated
the need for future research to focus on interventions that will address and reduce the
emotional distress of patients who sustain orthopaedic injuries.
Please refer to the April 2009 issue for the complete text. In the event you need to order a back issue, please click here.
— April 2009
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