Hospital Anxiety and Depression Scale Trajectories and Risk of Complex Regional Pain Syndrome in Middle-Aged Women After Surgical Treatment of Acute Distal Radial Fracture: A Prospective Longitudinal Cohort Study

IF 3.8 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2026-10-14 DOI:10.1002/ejp.70422

Meihui Gao, Jun Xiong, Ran Gao, Yun Shen, Shengdi Lu, Xiaoru Yang

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Abstract

Objective

To identify Hospital Anxiety and Depression Scale–Anxiety (HADS-A) trajectories after surgical treatment of distal radius fracture (DRF) in middle-aged women, and their association with complex regional pain syndrome (CRPS).

Design

Prospective longitudinal cohort study.

Setting

Tertiary hospital, China.

Participants

One thousand eight hundred seventy-five consecutive women aged 40–65 years undergoing surgical fixation of acute unilateral DRF (January 2019–December 2022).

Main Outcome Measures

Primary outcome was CRPS diagnosed by the Budapest Clinical Criteria at 3 months. HADS-A was measured at baseline and 1, 2, 3 and 6 months, with CRPS assessed at each follow-up. Latent class trajectory modelling (LCTM) defined trajectory classes; time in target range (TTR) was the proportion of assessments with HADS-A < 8.

Results

During 6-month follow-up, 150 women (8.0%) developed CRPS. LCTM identified four trajectories: low-stable (n = 983, 52.4%), moderate-recovering (n = 448, 23.9%), high-persistent (n = 265, 14.1%) and delayed-onset (n = 179, 9.5%). Incidence was 19.2% (high-persistent) versus 4.9% (low-stable). After adjustment, the high-persistent trajectory was associated with CRPS (odds ratio [OR] 4.85, 95% confidence interval [CI] 1.85–12.71; p = 0.001). TTR showed a graded exposure–response relationship: 0% versus 100% TTR carried higher risk (adjusted OR: 4.97, 95% CI: 2.51–9.86; p < 0.001; p for trend < 0.001). Subgroup interactions were non-significant.

Conclusions

Persistently elevated postoperative anxiety, rather than transient distress confined to the perioperative period, was associated with CRPS after DRF surgery, with a graded exposure–response relationship between cumulative anxiety burden (HADS-A TTR) and risk. Serial psychological monitoring beyond baseline may help identify at-risk patients.

Significance Statement

This study provides the first evidence that longitudinal anxiety trajectory patterns, not single-timepoint assessments, independently predict complex regional pain syndrome after distal radius fracture surgery. By introducing the “time in target range” concept to psychological measurement, we demonstrate a dose–response relationship between cumulative anxiety burden and CRPS risk. These findings reframe the longstanding debate on psychological contributors to CRPS and support serial anxiety monitoring as a clinically actionable strategy for early identification of at-risk patients.

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一项前瞻性纵向队列研究：急性桡骨远端骨折术后中年妇女医院焦虑和抑郁量表轨迹及复杂局部疼痛综合征的风险

目的：探讨中年女性桡骨远端骨折（DRF）术后医院焦虑抑郁量表-焦虑（HADS-A）变化轨迹及其与复杂区域疼痛综合征（CRPS）的关系。设计：前瞻性纵向队列研究。单位：中国三级医院。参与者：1,875名年龄在40-65岁之间的女性连续接受手术固定急性单侧DRF（2019年1月- 2022年12月）。主要结局指标：主要结局是3个月时布达佩斯临床标准诊断的CRPS。在基线和1、2、3和6个月时测量HADS-A，并在每次随访时评估CRPS。潜类轨迹建模（LCTM）定义轨迹类别；结果：在6个月的随访中，150名妇女（8.0%）发生CRPS。LCTM确定了四种轨迹：低稳定（n = 983, 52.4%）、中度恢复（n = 448, 23.9%）、高持续（n = 265, 14.1%）和延迟发病（n = 179, 9.5%）。发病率分别为19.2%（高持续性）和4.9%（低稳定性）。调整后，高持续性轨迹与CRPS相关（优势比[OR] 4.85, 95%可信区间[CI] 1.85-12.71; p = 0.001）。TTR表现出分级暴露-反应关系：0%与100% TTR具有更高的风险（调整后OR: 4.97, 95% CI: 2.51-9.86; p）结论：持续升高的术后焦虑，而不是局限于围手术期的短暂焦虑，与DRF手术后CRPS相关，累积焦虑负担（HADS-A TTR）与风险之间存在分级暴露-反应关系。超出基线的连续心理监测可能有助于识别高危患者。意义声明：本研究首次提供了纵向焦虑轨迹模式，而非单一时间点评估，独立预测桡骨远端骨折术后复杂区域疼痛综合征的证据。通过将“目标范围内时间”概念引入心理测量，我们证明了累积焦虑负担与CRPS风险之间存在剂量-反应关系。这些发现重新定义了长期以来关于心理因素对CRPS的影响的争论，并支持连续焦虑监测作为早期识别高危患者的临床可行策略。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.