Characteristics of pain, psychological burden, substance use, and stigma after traumatic orthopedic injury

The period following orthopedic trauma is a critical window for developing psychological burden, prolonged opioid use, and opioid-related stigma. Stigma refers to shame or perceived judgment related to opioid use, which may impair postoperative pain management and patient-provider trust. Although stigma is increasingly recognized as a recovery barrier, its relationship to pain, psychological factors, and opioid use duration remains poorly understood.

To characterize patterns of psychological factors, substance use, concerning opioid use (opioid misuse), and stigma by opioid use duration (0-29 days, 30 -59 days, and ≥ 60 days) during the three-month period following hospitalization for musculoskeletal trauma.

In this prospective observational cohort study, 170 adults hospitalized for orthopedic traumatic injuries were enrolled and followed for three months post-discharge. Clinical data were obtained from electronic health records and the state prescription drug monitoring program, and participants completed validated assessments of pain, psychological symptoms, opioid misuse, and stigma. Participants were categorized by opioid use duration into 0-29 days, 30-59 days, and ≥ 60 days.

Of the 170 participants, 135 (79 %) completed follow-up. Longer opioid use duration was significantly associated with greater inpatient pain intensity, depression, anxiety, pain-related anxiety, and traumatic distress. These trends persisted at follow-up, where participants with longer use demonstrated higher pain intensity, greater opioid exposure, and worse psychological and functional outcomes. Indicators concerning opioid use (opioid misuse) were common; the most frequently endorsed behaviors included running out of medication early (33 %) and anxiety when medication ran out (36 %). Experiences of stigma were reported by 17 % of participants and increased to 52 % among those using opioids for ≥ 60 days (p < .001). Internalized stigma (31 %) and stigma-related behaviors, including taking less medication than needed (24 %), also increased with longer opioid use duration.

Prolonged opioid use after traumatic musculoskeletal injury was associated with greater pain, psychological burden, concerning opioid use, and experiences of stigma. Findings underscore the interrelated nature of pain, mental health, and stigma in post-injury recovery and highlight the need for integrated interventions targeting pain-related distress, effective coping, and stigma reduction to support safer opioid use and improved functional outcomes.