Changes in Pain-Related Psychological Distress After Surgery in Patients with Musculoskeletal Injury
2025
Grant H. Cabell | Billy I. Kim | Kevin A. Wu | Emily J. Luo | Clark Bulleit | Nicholas J. Morriss | Trevor A. Lentz | Brian C. Lau
(1) Background: Pain experiences are shaped by both physical injury and psychological distress, posing challenges for orthopedic care. While surgery may alleviate injury-related distress, the extent of psychological improvement post surgery remains unclear. Thus, the purpose of this study was to evaluate changes in general and pain-specific psychological distress after surgical intervention for musculoskeletal injury. (2) Methods: A retrospective review was conducted on 133 patients who underwent musculoskeletal surgery between February 2020 and August 2022 by a single sports medicine fellowship-trained surgeon. Psychological distress was assessed using the Optimal Screening for Prediction of Referral and Outcome Yellow-Flag (OSPRO-YF) tool, both before and at least six months after surgery. Pre- and postoperative scores were compared using paired t-tests, and clinically meaningful changes were evaluated using a distribution-based minimal clinically important difference (MCID) threshold. (3) Results: Significant reductions were found in total OSPRO-YF scores and several subdomains including fear avoidance (physical activity and work), kinesiophobia, and pain anxiety. However, 88% of patients showed no meaningful change in overall psychological distress. In patients with high baseline distress, over 20% showed meaningful improvement in six subdomains. (4) Conclusions: Psychological distress often persists after musculoskeletal surgery. Targeted psychological interventions may benefit patients with high preoperative distress.
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