Journal of pain research · 2026
Acute Pain Trajectory Phenotypes are Associated with Kinesiophobia and Functional Recovery in Surgical/Trauma ICU Patients: A 5-Year Retrospective Cohort Study Using a PERMA-Informed Framework.
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Li Yun, Wang Hao, Lu Peng, Jia Wei, Gao Yu, Liu Wei, Wang Kun, Ma Jie, Liu Xiaoqiu
Аннотация
BACKGROUND: Early mobilization (EM) mitigates Post-Intensive Care Syndrome (PICS). However, kinesiophobia (fear of movement) driven by severe acute pain is often overlooked. This study aimed to identify acute pain trajectory phenotypes, evaluate their association with kinesiophobia, and explore outcomes under a PERMA-informed exploratory framework.
METHODS: A single-center retrospective cohort study was conducted including surgical/trauma ICU patients (January 2021-December 2025). Group-based trajectory modeling (GBTM) identified latent classes of pain over the first 5 ICU days. Kinesiophobia and PERMA-related proxy variables (Relationships, Accomplishment) were extracted. Multivariable logistic regression, restricted cubic splines (RCS), and Cox proportional hazards models assessed outcomes.
RESULTS: Among 586 eligible patients, four pain trajectories were identified: "Rapid Relief" (38.4%), "Persistent Moderate" (29.5%), "Delayed Onset/Flare-up" (21.3%), and "Persistent Severe" (10.8%). After adjusting for confounding factors, Delayed Onset (Adjusted OR 3.85, 95% CI 2.15-6.84) and Persistent Severe (Adjusted OR 6.12, 95% CI 3.25-11.56) trajectories were independently associated with kinesiophobia. RCS demonstrated a significant plateauing association between cumulative opioid doses and kinesiophobia. Patients with kinesiophobia exhibited significant delays in first out-of-bed mobilization, prolonged ICU lengths of stay, and a reduced likelihood of direct discharge to home. In adjusted outcome models, kinesiophobia was associated with delayed first target mobilization (HR 0.42, 95% CI 0.33-0.54, P<0.001) and lower odds of direct-to-home discharge (OR 0.21, 95% CI 0.14-0.32, P<0.001).
CONCLUSION: Acute pain in surgical/trauma ICU patients is highly heterogeneous. Higher-risk pain trajectory phenotypes were associated with kinesiophobia, which may represent a psychological barrier to functional recovery. Prospectively testing PERMA-informed strategies-particularly family support, meaning-oriented reframing, and goal-based achievement-may help clarify whether this approach can disrupt the pain-fear-immobility cycle.
METHODS: A single-center retrospective cohort study was conducted including surgical/trauma ICU patients (January 2021-December 2025). Group-based trajectory modeling (GBTM) identified latent classes of pain over the first 5 ICU days. Kinesiophobia and PERMA-related proxy variables (Relationships, Accomplishment) were extracted. Multivariable logistic regression, restricted cubic splines (RCS), and Cox proportional hazards models assessed outcomes.
RESULTS: Among 586 eligible patients, four pain trajectories were identified: "Rapid Relief" (38.4%), "Persistent Moderate" (29.5%), "Delayed Onset/Flare-up" (21.3%), and "Persistent Severe" (10.8%). After adjusting for confounding factors, Delayed Onset (Adjusted OR 3.85, 95% CI 2.15-6.84) and Persistent Severe (Adjusted OR 6.12, 95% CI 3.25-11.56) trajectories were independently associated with kinesiophobia. RCS demonstrated a significant plateauing association between cumulative opioid doses and kinesiophobia. Patients with kinesiophobia exhibited significant delays in first out-of-bed mobilization, prolonged ICU lengths of stay, and a reduced likelihood of direct discharge to home. In adjusted outcome models, kinesiophobia was associated with delayed first target mobilization (HR 0.42, 95% CI 0.33-0.54, P<0.001) and lower odds of direct-to-home discharge (OR 0.21, 95% CI 0.14-0.32, P<0.001).
CONCLUSION: Acute pain in surgical/trauma ICU patients is highly heterogeneous. Higher-risk pain trajectory phenotypes were associated with kinesiophobia, which may represent a psychological barrier to functional recovery. Prospectively testing PERMA-informed strategies-particularly family support, meaning-oriented reframing, and goal-based achievement-may help clarify whether this approach can disrupt the pain-fear-immobility cycle.