Is Pain in the Uninjured Arm Associated With Unhelpful Thoughts and Distress Regarding Symptoms During Recovery From Upper-Extremity Injury?

Chase Romere; Sina Ramtin; Carl Nunziato; David Ring; David Laverty; Austin Hill

doi:10.1016/j.jhsa.2023.03.019

Is Pain in the Uninjured Arm Associated With Unhelpful Thoughts and Distress Regarding Symptoms During Recovery From Upper-Extremity Injury?

J Hand Surg Am. 2023 May 17:S0363-5023(23)00170-3. doi: 10.1016/j.jhsa.2023.03.019. Online ahead of print.

Authors

Chase Romere¹, Sina Ramtin¹, Carl Nunziato¹, David Ring², David Laverty¹, Austin Hill¹

Affiliations

¹ Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX.
² Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX. Electronic address: David.Ring@austin.utexas.edu.

PMID: 37204359
DOI: 10.1016/j.jhsa.2023.03.019

Abstract

Purpose: During recovery from upper-extremity injury, patients sometimes express concerns regarding pain associated with increased use of the uninjured limb. Concerns about discomfort associated with increased use may represent a manifestation of unhelpful thoughts such as catastrophic thinking or kinesiophobia. We asked the following questions: (1) Among people recovering from an isolated unilateral upper-extremity injury, is pain intensity in the uninjured arm associated with unhelpful thoughts and feelings of distress regarding symptoms, accounting for other factors? (2) Is pain intensity in the injured extremity, magnitude of capability, or accommodation of pain associated with unhelpful thoughts and feelings of distress regarding symptoms?

Methods: In this cross-sectional study of new or returning patients presenting to a musculoskeletal specialist for care for an upper-extremity injury, the patients completed scales that were used to measure the following: pain intensity in the uninjured arm, pain intensity in the injured arm, upper-extremity-specific magnitude of capability, symptoms of depression, symptoms of health anxiety, catastrophic thinking, and accommodation of pain. Multivariable analysis was used to evaluate factors associated with pain intensity in the uninjured arm, pain intensity in the injured arm, magnitude of capability, and pain accommodation, controlling for other demographic and injury-related factors.

Results: Greater pain intensity in both uninjured and injured arms was independently associated with greater unhelpful thinking regarding symptoms. A greater magnitude of capability and pain accommodation were independently associated with less unhelpful thinking regarding symptoms.

Conclusions: Given that greater pain intensity in the uninjured upper extremity is associated with greater unhelpful thinking, clinicians can be attuned to patient concerns about contralateral pain. Clinicians can facilitate recovery from upper-extremity injury by evaluating the uninjured limb as well as identifying and ameliorating unhelpful thinking regarding symptoms.

Type of study/level of evidence: Prognostic II.

Keywords: Distress; unhelpful thoughts; uninjured arm; upper-extremity capability.