Post Traumatic Chronic Pain
Conditions
Keywords
Post traumatic Chronic Pain, Intensive Care Units, Biopsychosocial model
Brief summary
This study aims to assess multidimensional risk factors for chronic post-traumatic pain in polytrauma patients. The purpose is to better understand pain chronification mechanisms by quantifying the interaction between clinical, biological, therapeutic, and psychosocial factors during hospitalization, with the ultimate goal of developing a convergent model to predict patients at risk before hospital discharge.
Detailed description
According to the International Classification of Diseases 11th (ICD-11) classification, chronic post-traumatic pain is defined as pain persisting for more than 3 months following tissue injury. Given its physical, psychological, and social consequences, chronic pain represents a major source of disability, functional limitation, and impaired quality of life. Chronic pain frequently develops after accidental trauma, particularly in patients sustaining musculoskeletal injuries such as fractures. The primary objective of this study is to identify early risk factors associated with chronic post-traumatic pain. In this study, patients undergo a comprehensive multidimensional evaluation throughout hospitalization. Trauma-related characteristics, including injury mechanism, severity, and lesion location, as well as therapeutic management, are systematically documented. Psychosocial factors and post-traumatic symptoms are assessed during hospitalization and at 3- and 6-month follow-up visits. In addition to clinical and psychosocial assessments, biological samples are collected from hospital admission until discharge. This biological component focuses on brain-derived neurotrophic factor (BDNF). BDNF, initially described for its role in synaptic plasticity, has been increasingly implicated in central sensitization processes involved in pain chronification. By integrating clinical, biological, therapeutic, and psychosocial data, this study aims to characterize mechanisms associated with chronic post-traumatic pain and to develop a convergent predictive model to identify patients at high risk prior to hospital discharge.
Interventions
OTHERbiological collection of residual peripheral venous blood samples
use of samples from this collection for BDNF (Brain-Derived Neurotrophic Factor) analysis
collection of data from medical records
Sponsors
University Hospital, Montpellier
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients aged 18 years or older * Patients with an Abbreviated Injury Scale (AIS) score greater than 1 * Patients presenting with at least one documented fracture
Exclusion criteria
* Patients with an isolated fracture of the carpal bones * Patients with isolated traumatic brain injury * Patients with isolated minor facial trauma * Patients with isolated digestive trauma
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Chronic post-traumatic pain | more than 3 months post-trauma | Presence of chronic post-traumatic pain, defined as a visual analog scale (VAS) score greater than 3 persisting more than 3 months post-trauma. The Visual Analog Scale (VAS) Scores range from 0 (no pain) to 10 (worst imaginable pain). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Behavioral Pain Scale (BPS) Score | From ICU admission until extubation | Pain assessed using the Behavioral Pain Scale (BPS) in mechanically ventilated and intubated patients. Scores range from 3 (no pain) to 12 (maximum pain). |
| Visual Analog Scale (VAS) Pain Score | From hospital admission until 6 months post-trauma | Pain intensity assessed using a visual analog scale (VAS). Scores range from 0 (no pain) to 10 (worst imaginable pain). |
| Injury Severity Score (ISS) | At ICU admission | Severity of traumatic injuries assessed using the Injury Severity Score. Scores range from 1 (minor injury) to 75 (most severe injury). |
| Pain Catastrophizing Profile | During ICU stay up to 28 days | Pain catastrophizing assessed using the Pain Catastrophizing Scale (PCS) as soon as the patient is able to self-report during the ICU stay. Scores range from 0 (no catastrophizing) to 52 (maximum catastrophizing). |
| Trait Anxiety (STAI-Trait) | Once during ICU stay (up to 28 days) when the patient is conscious and able to self-report | Trait anxiety assessed using the State-Trait Anxiety Inventory - Trait subscale (STAI-Trait) as soon as the patient is conscious and able to self-report during the ICU stay. Scores range from 20 (low trait anxiety) to 80 (high trait anxiety). |
| Anxiety Intensity (Visual Analog Scale) | From hospital admission through 6 months post-trauma | State anxiety intensity assessed using a Visual Analog Scale (VAS) in non-intubated patients able to self-report during the ICU stay, and during follow-up up to 6 months post-trauma.Scores range from 0 (no anxiety) to 10 (worst imaginable anxiety). |
| Neuropathic Pain Characteristics (DN4 Questionnaire) | During ICU stay and at 3 and 6 months post-trauma | Neuropathic pain characteristics assessed using the DN4 questionnaire as soon as the patient is able to self-report during hospitalization if pre-existing chronic pain is present, and reassessed at 3 and 6 months post-trauma in patients reporting pain.Scores range from 0 (no neuropathic pain) to 10 (definite neuropathic pain). |
| Brief Pain Inventory (BPI) | At 3 and 6 months post-trauma after hospital discharge | Pain assessed with the Brief Pain Inventory (BPI), including two subscales: pain severity and pain interference. Both subscale scores range from 0 (no pain / no interference) to 10 (worst pain / maximum interference). |
| Post-Traumatic Stress Symptoms (PCL-5) | 3 and 6 months post-trauma | Post-traumatic stress symptoms assessed with the PCL-5 questionnaire. Scores range from 0 (no symptoms) to 80 (severe symptoms). |
| Opioid Misuse (POMI) | 3 and 6 months post-trauma | Opioid misuse assessed with the POMI questionnaire. Scores range from 0 (no misuse) to 6 (high risk of misuse). |
| Quality of Life (SF-12) | 3 and 6 months post-trauma | Quality of life assessed with the SF-12 questionnaire, including two component scores: Physical Component Summary (PCS) and Mental Component Summary (MCS). Scores are standardized on a 0 to 100 scale, with higher scores indicating better quality of life. |
| Anxiety and Depression (HADS) | 3 and 6 months post-trauma | Anxiety and depression assessed with the Hospital Anxiety and Depression Scale (HADS), including two subscales: anxiety and depression. A total score is also calculated by summing both subscales. Each subscale score ranges from 0 to 21, and the total score ranges from 0 (no symptoms) to 42 (severe anxiety and depression). |
Countries
France
Contacts
CONTACTSophie Bringuier, PhD
STUDY_DIRECTORCAPDEVILA Xavier, MD PhD
x-capdevila@chu-montpellier.fr
Outcome results
None listed