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Abstract
Introduction Pain is an expected and appropriate experience following traumatic musculoskeletal injury. By contrast, chronic pain and disability are unhelpful yet common sequelae of trauma-related injuries. Presently, the mechanisms that underlie the transition from acute to chronic disabling post-traumatic pain are not fully understood. Such knowledge would facilitate the development and implementation of precision rehabilitation approaches that match interventions to projected risk of recovery, with the aim of preventing poor long-term outcomes. The aim of this study is to identify a set of predictive factors to identify patients at risk of developing ongoing post-traumatic pain and disability following acute musculoskeletal trauma. To achieve this, we will use a unique and comprehensive combination of patient-reported outcome measures, psychophysical testing and biomarkers.
Methods and analysis A prospective observational study will recruit two temporally staggered cohorts (n=250 each cohort; at least 10 cases per candidate predictor) of consecutive patients with acute musculoskeletal trauma aged ≥16 years, who are emergency admissions into a Major Trauma Centre in the United Kingdom, with an episode inception defined as the traumatic event. The first cohort will identify candidate predictors to develop a screening tool to predict development of chronic and disabling pain, and the second will allow evaluation of the predictive performance of the tool (validation). The outcome being predicted is an individual’s absolute risk of poor outcome measured at a 6-month follow-up using the Chronic Pain Grade Scale (poor outcome ≥grade II). Candidate predictors encompass the four primary mechanisms of pain: nociceptive (eg, injury location), neuropathic (eg, painDETECT), inflammatory (biomarkers) and nociplastic (eg, quantitative sensory testing). Concurrently, patient-reported outcome measures will assess general health and psychosocial factors (eg, pain self-efficacy). Risk of poor outcome will be calculated using multiple variable regression analysis.
Ethics and dissemination Approved by the NHS Research Ethics Committee (17/WA/0421).
- musculoskeletal trauma
- precision rehabilitation
- pain mechanisms
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Footnotes
Contributors DF is Chief Investigator and guarantor. DF and ABR led protocol development, data analysis and dissemination. DWE is the Research Fellow with responsibility for study management. NM is a Doctoral Researcher focused to this study. NRH is the lead for patient and public involvement. JMP is the Principal Investigator at the Major Trauma Centre. JMP and CS are clinical representatives at the Major Trauma Centre. JL is the lead for biomarker evaluation. All authors will contribute to data interpretation, conclusions and dissemination. ABR drafted the initial manuscript with DF. Subsequent drafts were developed with DWE. All reviewers have read, contributed to and agreed upon the final manuscript.
Funding This work was supported by the National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre (NIHR SRMRC) to DF and ABR.
Competing interests None declared.
Patient consent Not required.
Ethics approval Approved by the NHS Research Ethics Committee (17/WA/0421).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.