A cognitive therapy program is optimizing recovery from traumatic orthopedic injuries and shows potential for improving physical pain and easing emotional discomfort.
Up to half of people develop persistent pain after traumatic orthopedic injuries, most often from broken bones or dislocations from automobile accidents. After surgery, these severe injuries — not only the physical pain but also the associated psychological trauma – require time to heal.
“They are healthy one day, have an accident, and then their life is turned upside down,” said Kristin Archer, Ph.D., professor and vice chair of Research Orthopaedic Surgery at Vanderbilt University Medical Center (VUMC). “They may look fine a few months later, but some with persistent pain develop depressive symptoms or post-traumatic stress disorder.”
Addressing Persistent Pain
Archer has been part of the team that tested a post-injury toolkit for optimal recovery after traumatic orthopedic injury. The toolkit provides patients at risk for persistent pain with the psychological skills to successfully navigate recovery.
“The four, weekly mind/body video sessions integrate mindfulness techniques with cognitive therapy to help patients cope and manage their pain better at home.”
“The four, weekly mind/body video sessions integrate mindfulness techniques with cognitive therapy to help patients cope and manage their pain better at home,” Archer said. “This is one of the first psychosocial interventions for traumatic injury that looks promising.”
A recent pilot study published in Clinical Orthopaedics and Related Research tested the toolkit in 195 adults with an acute orthopedic traumatic injury who were at risk for persistent pain. Half of the adults, who were treated at four geographically diverse trauma centers, were randomized to receive the toolkit. The other half were given an educational pamphlet that outlined the recovery process.
Use of the toolkit led to meaningful improvements in physical function, pain, activity levels, and symptoms of depression and PTSD, as well as in pain anxiety, catastrophizing, coping and mindfulness in those patients. Importantly, the toolkit group sustained or furthered these improvements over a three-month period, suggesting it may help prevent the transition from acute to chronic pain.
3 Core Coping Strategies
The video sessions teach three main coping skills, all of which have been proven as powerful recovery strategies.
- Practice deep breathing to reduce stress and improve focus.
- Recognize negative thoughts and replace them with positive ones.
- Set goals and design a plan for moving forward.
About a third of patients with traumatic orthopedic injuries are resilient and ultimately do well. However, those suffering acute pain during the first three months after the injury often develop persistent pain.
“These people tend to have higher anxiety, hyperfocus on pain, have fear of movement, and low self-confidence,” Archer said. “That’s why we focus on goal setting.”
Toolkit participants managed to return to work and daily activities despite the pain.
“They found ways to manage without relying on opioids or simply lying on the couch. They felt better about themselves and got back on track,” Archer said.
Understanding Psychosocial Effects
The researchers have submitted a grant to the National Institutes of Health to continue this line of work in a larger population of trauma survivors.
“It’s important to understand the psychosocial profile of these patients, to note how severe their pain is, and how we can help manage it.”
“It’s important to understand the psychosocial profile of these patients, to note how severe their pain is, and how we can help manage it,” Archer said.
The VUMC trauma center provides educational information to all orthopedic trauma patients. Surgeons also are trained to screen for high-risk patients and discuss psychosocial issues with them.
“Once screened, we send them to trained physical therapists, get them into community support groups and help them find classes in mindfulness breathing and yoga,” Archer said.
