Cognitive-behavioral determinants of pain and disability two years after traumatic injury: A cross-sectional survey study

Kristin R. Archer, Christine M. Abraham, Yanna Song, William T. Obremskey

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


BACKGROUND: Approximately, 2.5 million trauma survivors are hospitalized each year, with the majority experiencing prolonged and profound pain-related disability. The present study investigated the association between fear of movement and pain catastrophizing and pain and physical health 2 years after high-energy trauma. METHODS: One hundred eight adult patients admitted to a Level I trauma intensive care unit, between July 2006 and July 2007, were contacted by phone 2 years after multiple trauma. Eighty-four (78%) participants completed measures of fear of movement, pain catastrophizing, pain intensity and interference with activity, and physical health. Patient and injury characteristics were abstracted from the medical record and a research database. Hierarchical multivariable linear regression analyses examined the unique contribution of fear of movement and pain catastrophizing to pain and physical health outcomes. RESULTS: Fear of movement and catastrophizing explained a significant proportion of variance in pain intensity (29%), pain interference (34%), and physical health (19%), after controlling for age, sex, intensive care unit stay, and depression. Fear of movement and pain catastrophizing were independently associated with pain intensity and physical health, but only pain catastrophizing was associated with pain interference (p <0.05). CONCLUSIONS: Results suggest that fear of movement and catastrophizing are risk factors for poor long-term outcomes after traumatic injury. Prospective studies are warranted to test the fear-avoidance model and determine whether the model may be relevant for explaining the development of chronic pain and disability in trauma survivors. The identification of subgroups based on negative pain beliefs may have the potential to improve outcomes after traumatic injury.

Original languageEnglish (US)
Pages (from-to)473-479
Number of pages7
JournalThe journal of trauma and acute care surgery
Issue number2
StatePublished - Feb 2012
Externally publishedYes


  • Pain
  • Pain catastrophizing
  • Pain-related fear
  • Surgical outcomes

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery
  • Medicine(all)


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