AAHS Home  |  2021 Virtual Portal  |  Past & Future Meetings
Countdown to AAHS : 34 Days  
American Association for Hand Surgery

Back to 2022 Abstracts


Effect of Resiliency on Post-Steroid Injection Pain in Patients with Thumb Carpometacarpal Osteoarthritis
Christopher J. Lama, MS1, Edgar Garcia-Lopez, MD MS1, Edward Akelman, MD2, Christopher J. Got, MD3, Arnold-Peter C Weiss, MD4, Julia A. Katarincic, MD5 and Joseph A. Gil, MD1, (1)Brown University, Providence, RI, (2)Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, (3)Dept of Orthopedics, Brown University, Providence, RI, (4)Alpert Medical School of Brown University, Providence, RI, (5)Department of Orthopaedic Surgery, Brown University, Providence, RI

Introduction
There is increasing evidence that psychological resilience plays a significant role in symptom intensity and limitations following orthopaedic procedures. Resilience has been shown to affect outcomes in total shoulder and knee arthroplasty, as well as Bankart repair. However, there is limited research on the influence of resilience in hand surgery procedures and particularly intra-articular corticosteroid-lidocaine injections for thumb carpometacarpal (CMC) osteoarthritis. In this study, we aimed to determine if resilience was associated with post corticosteroid-lidocaine injection pain in patients with thumb CMC osteoarthritis.

Materials & Methods
Patients with CMC osteoarthritis undergoing intra-articular corticosteroid-lidocaine injections at a single institution were prospectively enrolled. Subjects completed a pre-injection Brief Resilience Scale (BRS) and visual analogue scale (VAS) for pain, followed by a VAS score one minute after the injection. Patients were asked to focus on the administration of injectate and pain immediately following the injection. Generalized estimating equations were used to understand the effect of baseline BRS resilience (low, medium, high) on patient characteristics and VAS pain pre and post-injection, while generalized linear regression models were used to understand the effect of resilience on change in pain.

Results
There are no differences in patient baseline characteristics across BRS categories (Table 1 and 2). BRS categories were significantly related to VAS pain post scores (p<0.0001), with increasing resiliency being associated with a decrease in pain. Post hoc comparisons showed that the high and medium resilience groups had significantly lower VAS pain post scores than the low resilience group (3.1 and 2.7 vs. 6.5, p<0.0001). BRS categories were significantly related to change in pain (p=0.01), with increasing resiliency being associated with greater reduction in pain. Post hoc pairwise comparisons showed that the high and medium resilience groups had significantly greater reduction in pain than the low resiliency group (-3.9 and -3.3 vs. -0.4, p=0.02 and p=0.02 respectively).

Conclusions
The results from this study suggest that resiliency may affect the perceived pain after a CMC injection. Those who were more resilient had significantly lower pain after this injection than those with low resiliency. Baseline pain did not differ significantly between resiliency level categories; however, when change in pain from baseline to post-injection was assessed those who were more resilient perceived a greater reduction in pain (3-4 points). These findings are clinically relevant as BRS measured resilience can guide clinicians in predicting which subset of CMC patients will experience more pain with a steroid injection.


Back to 2022 Abstracts