How can we best identify and manage patients with persistent pain after wrist fracture -

 a qualitative service evaluation and systematic review 

Summary

Wrist fractures account for 1/6th of all emergency department visits (MacIntyre 2016). It is normal to experience pain following wrist fracture, but once acutely managed this pain should subside. 16% of patients with a wrist fracture will develop persistent post fracture pain (PPFP) i.e. ongoing pain at 1-year post injury (Cashin 2019). The result is a delay in returning to work and leisure activities.

There is some evidence to suggest that identifying those people with PPFP early, and referring them for rehabilitation with a physio/occupational therapist as well as to pain management and psychological services, can significantly improve their chances of avoiding a chronic pain condition, such as the debilitating chronic pain condition Complex Regional Pain Syndrome (CRPS). Recent research, using a Freedom of Information request paradigm, tells us that very few hospital Trusts have pathways in place that enable early identification and treatment of patients with PPFP (Gillespie 2018). Specifically, there are no validated tools available to help clinicians identify those most at risk of going on to develop PPFP, and who would benefit most from access to multidisciplinary pain rehabilitation services.

The Predoctoral Clinical Academic Fellowship (PCAF) is an opportunity to broaden research skills, specifically in the specialities of prognostic modelling and assessment of pain. This will enable the development of a competitive and informed doctoral application to design a secondary care risk stratification tool for persistent pain after wrist fracture, for use with stratified care pathways. This approach could be a cost-effective way to improve pain outcomes and patient experience.