Pain Interference Prior to and 1 Year After Surgery for Adult Traumatic Brachial Plexus Injury

Washington University School of Medicine - St. Louis MO USA

Brogan DM; Loeffler BJ; Lee SK; Chim HWM; Desai MJ; Tuffaha S; Liu Y; PLANeT Study Group

INTRODUCTION: Pain after brachial plexus injury (BPI) can be severely debilitating and is poorly understood. We hypothesized that pain interference (“extent to which pain hinders engagement in life”) would be predicted by depression, anxiety, severity of pain symptoms, and poorer preoperative muscle function.

METHODS: Among patients in a prospective multicenter BPI cohort study, 37 completed PROMIS pain interference (PI) questionnaires before surgery and 1 year after surgery. At both times, participants completed anxiety and depression questionnaires and BPI-specific measures of pain symptoms, physical limitations, and emotional recovery. Surgeon-graded muscle testing, injury severity, age at injury, body mass index, and time from injury to surgery were included. We performed univariate analysis of predictors for pre-op and 1-year PROMIS PI followed by multivariable regression modeling using stepwise selection and Bayesian Information Criterion to select covariates.

RESULTS: Before surgery, mean PROMIS PI was 60.8±11.0, with moderate correlations between PROMIS PI and depression, as well as between PROMIS PI and functional limitations. At 1-year after surgery, mean PROMIS PI was 59.7±9.5. There was no difference in preoperative and 1-year PROMIS PI. There were strong correlations between PROMIS PI and pain symptoms, functional limitations, and emotional aspects of recovery at 1-year follow-up that remained significant in multivariable regression. There were no significant associations between muscle testing and pain interference.

CONCLUSIONS: Pain interference remained substantial and elevated in BPI patients 1 year after surgery. We noted strong associations between pain interference and pain symptoms, functional limitations, and emotional aspects of recovery. These findings demonstrate a notable relationship between pain interference and patient-reported outcomes. Addressing pain is a tremendous opportunity to improve quality of life and should be a priority for both clinicians and researchers.