The Biopsychosocial Model to Identify Risk Factors for Chronic Postoperative Pain in Orthopedic Trauma Surgery Patients

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.

Traumatic fractures requiring surgical treatment are among the most common causes of severe acute pain and may result in persistent pain despite fracture healing and satisfactory surgical outcomes. Chronic post-traumatic pain following orthopedic trauma surgery is associated with prolonged functional impairment, delayed return to work, psychological distress, and decreased quality of life.

Current evidence suggests that chronic post-traumatic pain results from a complex interaction between injury-related characteristics, biological vulnerability, therapeutic management, and psychosocial factors. However, these multidimensional determinants remain incompletely understood in orthopedic trauma populations.

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. Fracture-related characteristics, including fracture location, injury severity, surgical management, analgesic strategies, and rehabilitation pathways, 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.

• Visual Analog Scale (VAS) Pain Score [Срок оценки: From hospital admission until 6 months post-trauma]
• Injury Severity Score (ISS) [Срок оценки: Baseline (At hospital admission, day 0)]
• Pain Catastrophizing Profile [Срок оценки: Baseline (At hospital admission, day 0)]
• Trait Anxiety (STAI-Trait) [Срок оценки: Baseline (At hospital admission, day 0)]
• Anxiety Intensity (Visual Analog Scale) [Срок оценки: From hospital admission through 6 months post-trauma]
• Neuropathic Pain Characteristics (DN4 Questionnaire) [Срок оценки: During hospitalization and at 3 and 6 months post-trauma]
• Brief Pain Inventory (BPI) [Срок оценки: At 3 and 6 months post-trauma]
• Post-Traumatic Stress Symptoms (PCL-5) [Срок оценки: At 3 and 6 months post-trauma]
• Opioid Misuse (POMI) [Срок оценки: At 3 and 6 months post-trauma]
• Quality of Life (SF-12) [Срок оценки: At 3 and 6 months post-trauma]
• Anxiety and Depression (HADS) [Срок оценки: At 3 and 6 months post-trauma]
• Serum BDNF Concentration [Срок оценки: From admission (before surgery ) until discharge (from day 1 to day 28)]