@article{ref1,
title="Association of claustrophobia and anxiety with cast intolerance in patients with extremity injuries",
journal="HSS journal",
year="2020",
author="Urch, Ekaterina and Kim, Julia M. and Rancy, Schneider K. and Saltzman, Eliana B. and Lee, Steve K. and Wolfe, Scott W.",
volume="16",
number="Suppl 2",
pages="383-393",
abstract="BACKGROUND: Patients undergoing casting for upper or lower extremity injuries may present with recalcitrant pain without an identifiable physiologic etiology, which  increases the likelihood of more frequent or unscheduled office visits, insomnia,  decreased patient satisfaction, unnecessary investigative procedures or treatments,  and-in some cases-cast intolerance. The exact causes of cast intolerance are not  well studied, although claustrophobia and associated fears of suffocation and  restriction may be underlying causes. QUESTIONS/PURPOSES: We sought to explore the  association between claustrophobic tendencies and cast intolerance. We hypothesized  that patients with claustrophobia or claustrophobic tendencies would have a higher  rate of cast intolerance. <br><br>METHODS: Patients requiring circumferential casting of an  upper or lower extremity were prospectively enrolled at the time of cast  application. Data were collected at each office visit until cast removal. Pre- and  post-casting anxiety were quantified using the Beck Anxiety Inventory(®) (BAI(®)). Pain was assessed at each visit using the visual analog scale (VAS). Claustrophobic  tendencies were evaluated after cast removal using the Claustrophobia Questionnaire  (CLQ). At the completion of the study, patients were assigned to either  the cast-tolerant or the cast-intolerance cohort according to predetermined  criteria. CLQ, BAI, and VAS scores were compared between cohorts. <br><br>RESULTS: Out of  199 patients enrolled, 4% (n = 8) met the criteria for cast intolerance. There was  no difference in BAI (anxiety) scores between groups at casting, but cast-intolerant  patients had significantly lower post-casting BAI scores than the cast-tolerant  controls, indicating a decrease in anxiety after cast removal. Taken together, both  groups demonstrated significant reduction in VAS scores from casting to cast  removal. The tolerant group had a significant reduction in VAS scores, whereas the  intolerant group did not. The intolerant group had a significant negative  correlation between initial VAS scores and final BAI scores. The tolerant group had  a significant positive correlation between initial VAS scores and final BAI scores,  as well as between final VAS scores and final BAI scores. Interestingly, no  difference in CLQ scores was seen between groups, although there were positive  correlations between CLQ scores and pre- and post-casting anxiety scores and between  CLQ and final VAS scores. <br><br>CONCLUSIONS: Our hypothesis was not supported. Although we  did not find a relationship between claustrophobia and cast intolerance, we did find  significant correlations between anxiety and pain. The tolerant group's initial and  final pain scores had significantly positive correlations to final anxiety,  suggesting that pain is likely to cause or increase anxiety; indeed, as pain  decreased, so did anxiety. The intolerant group, however, had a significant negative  correlation between initial pain and final anxiety scores. It would not be expected  that lower pain scores would increase anxiety. This may suggest that cast-intolerant  patients experience or report their anxiety as pain. These findings may explain why  some patients suffer from pain that cannot be explained by an underlying physiologic  process and is resistant to traditional pain management. A multidisciplinary  approach, including psychological and psychosocial assessments, may help identify  nonphysiologic components to pain. An accurate diagnosis for the cause of pain may  lead to nonpharmacological interventions and therefore reduce opioid use and overall  costs and improve patient outcomes.<p /> <p>Language: en</p>",
language="en",
issn="1556-3316",
doi="10.1007/s11420-020-09763-7",
url="http://dx.doi.org/10.1007/s11420-020-09763-7"
}