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Beaudoin FL, Gaither R, DeLomba WC, McLean SA. Tolerability and efficacy of duloxetine for the prevention of persistent musculoskeletal pain after trauma and injury: a pilot three-group randomized controlled trial. Pain 2023; 164:855-863. [PMID: 36375173 PMCID: PMC10014491 DOI: 10.1097/j.pain.0000000000002782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/30/2022] [Indexed: 11/15/2022]
Abstract
ABSTRACT This study investigated the tolerability and preliminary efficacy of duloxetine as an alternative nonopioid therapeutic option for the prevention of persistent musculoskeletal pain (MSP) among adults presenting to the emergency department with acute MSP after trauma or injury. In this randomized, double-blind, placebo-controlled study, eligible participants (n = 78) were randomized to 2 weeks of a daily dose of one of the following: placebo (n = 27), 30 mg duloxetine (n = 24), or 60 mg duloxetine (n = 27). Tolerability, the primary outcome, was measured by dropout rate and adverse effects. Secondary outcomes assessed drug efficacy as measured by (1) the proportion of participants with moderate to severe pain (numerical rating scale ≥ 4) at 6 weeks (pain persistence); and (2) average pain by group over the six-week study period. We also explored treatment effects by type of trauma (motor vehicle collision [MVC] vs non-MVC). In both intervention groups, duloxetine was well tolerated and there were no serious adverse events. There was a statistically significant difference in pain over time for the 60 mg vs placebo group ( P = 0.03) but not for the 30 mg vs placebo group ( P = 0.51). In both types of analyses, the size of the effect of duloxetine was larger in MVC vs non-MVC injury. Consistent with the role of stress systems in the development of chronic pain after traumatic stress, our data indicate duloxetine may be a treatment option for reducing the transition from acute to persistent MSP. Larger randomized controlled trials are needed to confirm these promising results.
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Affiliation(s)
- Francesca L. Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
- Department of Emergency Medicine, The Alpert Medical School of Brown University, Providence, RI, United States
| | - Rachel Gaither
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Weston C. DeLomba
- Department of Emergency Medicine, The Alpert Medical School of Brown University, Providence, RI, United States
| | - Samuel A. McLean
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
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Pacella-LaBarbara ML, Plaitano EG, Suffoletto BP, Kuhn E, Germain A, Jaramillo S, Repine M, Callaway CW. A longitudinal assessment of posttraumatic stress symptoms and pain catastrophizing after injury. Rehabil Psychol 2023; 68:32-42. [PMID: 36821344 PMCID: PMC10542514 DOI: 10.1037/rep0000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE/OBJECTIVE Identifying individuals with high levels of pain catastrophizing (PC) may inform early psychological interventions to prevent the transition from acute to chronic post-injury pain. We examined whether pre-and post-injury posttraumatic stress symptoms (PTSS) predict post-injury PC among emergency department (ED) patients following acute motor vehicle crash (MVC). RESEARCH METHOD/DESIGN This study represents secondary data analysis of a randomized clinical trial (NCT03247179) examining the efficacy of the PTSD Coach app on post-injury PTSS (PTSSpost). Among 63 injured ED patients (63% female; 57% non-White; average age = 37) with moderate pain (≥4 of 10), we assessed recall of pre-injury PTSS (PTSSrecall: stemming from preexisting exposures) and baseline PC within 24 hr post-MVC; PTSSpost stemming from the MVC was assessed 30-days later, and the outcome of PC was assessed at 90-days post-injury. We controlled for group assignment (intervention vs. control) in all analyses. RESULTS Results revealed that at baseline and 90-days, PC was higher among non-White versus White participants. After adjusting for relevant covariates, PTSSrecall uniquely predicted post-injury PC and each subscale of PC (helplessness, magnification, and rumination). Similarly, after controlling for PTSSrecall and relevant covariates, PTSSpost uniquely predicted total and subscale post-injury PC. Intervention group participants reported less rumination than control group participants. CONCLUSIONS/IMPLICATIONS These novel findings highlight that injured Black patients may be vulnerable to post-injury PC, and that both PTSSrecall and PTSSpost significantly predict post-injury PC. Brief PTSS assessment in the ED can identify high-risk patients who may benefit from early intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Eric Kuhn
- Department of Psychiatry and Behavioral Sciences
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Traumatic Life Experience and Pain Sensitization: Meta-analysis of Laboratory Findings. Clin J Pain 2023; 39:15-28. [PMID: 36524769 DOI: 10.1097/ajp.0000000000001082] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Psychological trauma often co-occurs with pain. This relationship has been explored using laboratory pain measures; however, findings have been mixed. Previous studies have limited operationalization of trauma (eg, posttraumatic stress disorder) or pain (eg, pain thresholds), which may contribute to conflicting results. Further, prior reviews likely underrepresent trauma experiences among people who are not receiving clinical care, limiting generalizability. MATERIALS AND METHODS We systematically reviewed the existing literature on the relationship between psychological trauma (eg, car accidents, sexual assault, childhood abuse, neglect) and laboratory pain (ie, quantitative sensory testing measures of pain threshold, intensity, summation, modulation), using inclusive criteria. The direction of the relationship between psychological trauma and pain sensitivity was evaluated, and moderation by purported pain mechanism (ie, pain detection, suprathreshold pain, central sensitization, inhibition) was explored. RESULTS Analyses were conducted using 48 studies that provided 147 effect sizes. A multivariate random-effects model with robust variance estimation resulted in a small but statistically significant overall effect size of g=0.24 (P=0.0002), reflecting a positive association between psychological trauma and enhanced laboratory pain sensitivity. Upon examination of mechanistic moderators, this relationship appears driven by effects on pain detection (g=0.28, P=0.002) and central sensitization (g=0.22, P=0.04). While effect sizes were similar across all moderators, effects on suprathreshold pain and inhibition were not statistically significant. DISCUSSION Findings demonstrate an overall pattern of trauma-related pain enhancement and point to central sensitization as a key underlying mechanism.
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Positive, but not negative, treatment outcome expectancies mediate the relation between depressive symptoms and treatment-related pain reduction. J Behav Med 2022:10.1007/s10865-022-00380-9. [DOI: 10.1007/s10865-022-00380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022]
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Park HR, Lee SK, Yoon SH, Jo HG, Kim JY, Kim H, Sul JU, Leem J. Positive short term effects of an integrative korean medicine treatment package for low back pain caused by motor vehicle accidents: A retrospective chart review of real – world practice data. Front Pharmacol 2022; 13:1003849. [DOI: 10.3389/fphar.2022.1003849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
Backgrounds No standard treatment exist for reducing symptoms related to sequelae of motor vehicle accidents (MVAs). In Korea, comprehensive Korean Medicine (KM) treatment that includes botanical drugs (herbal medicine), acupuncture, pharmacopuncture, tuina, moxibustion, and cupping is covered by automobile insurance and increasingly used to help alleviate such pain. This study aimed to analyze real-world data and to evaluate the effectiveness and safety of comprehensive KM treatment for low back pain caused by MVAs.Methods We conducted a retrospective chart review of patients who received KM treatment during hospitalization. Records that lacked follow-up outcome assessments were excluded. The Verbal Numerical Rating Scale (VNRS), the Korean version of the Oswestry Disability Index (K-ODI) and the Korean version of the Roland-Morris Disability Questionnaire (K-RMDQ) were evaluated at admission and discharge. Adverse events were also analyzed. A paired t-test was used to identify the effectiveness of KM treatment.Results A total of 50 patients, 30 males and 20 females, were included in the analysis. The mean age of the patients was 40.72 ± 13.31 years and the average treatment period was 7.22 ± 3.84 days. After treatment, VNRS, K-ODI and K-RMDQ were significantly improved (p < 0.001). There was a decrease from 5.06 ± 1.60 to 3.40 ± 1.81 in VNRS, 33.38 ± 16.88 to 24.54 ± 13.63 in K-ODI, and 6.84 ± 6.27 to 4.14 ± 4.38 in K-RMDQ. During this period, a total of two adverse events were reported.Discussion Although this retrospective chart review looked into the short term effects only, comprehensive KM treatment might be an effective and safe therapeutic option to reduce acute low back pain especially after MVA. Prospective research data is needed to support this hypothesis.
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Tan AC, Allen SK, Aziz I, Mercado M, Nanthakumar K, Syed F, Champion GD. Biopsychosocial sequelae of chronically painful injuries sustained in motor vehicle accidents contributing to non-recovery: A retrospective cohort study. Injury 2022; 53:3201-3208. [PMID: 35843753 DOI: 10.1016/j.injury.2022.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Claimants with chronically painful injuries sustained in motor vehicle accidents (MVAs) undergo assessment and management influenced by insurance and medico-legal processes defined by a biomedical paradigm which is discordant with best evidence. We aim to demonstrate the impact of biopsychosocial factors on post-MVA sequelae which contribute to non-recovery. METHODS This was a retrospective cohort study of medico-legal documents and reports on 300 consecutive claimants referred to a pain medicine physician over 7 years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. One hundred data items were extracted from the medico-legal documents and reports for each claimant and entered into an electronic database. Post-MVA sequelae were analysed using chi-square analysis (OR >2) for significant associations with demographic, pre-MVA and post-MVA variables. Factors with significant associations were entered into a logistic regression model to determine significant statistical predictors of post-MVA sequelae contributing to non-recovery. RESULTS The claimants were aged 17 to 80 years (mean age 42 years), and approximately half (53%, n=159) were female. The time from MVA to interview averaged 2.5 years. Widespread pain was present in 18% (n=54), and widespread somatosensory signs implying central sensitisation (OR=9.85, p<.001) was the most significant multivariate association. Long-term opiate use post-MVA (32%) was predicted by pre-MVA sleep disturbance (OR=5.08, p=.001), post-MVA major depressive disorder (MDD) (OR=3.02, p=.003) and long-term unemployment (OR=2.22. p=.007). Approximately half (47%, n=142) required post-MVA support from a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was diagnosed by a psychiatrist or psychologist in 20% (n=59), yet early identification of risk of PTSD was rare. Pre-MVA, 89.4% (n=268) were studying or employed. Permanent unemployability post-MVA occurred in 35% (n=104) and was predicted by MDD (OR=3.59, p=.001) and antidepressant use (OR=2.17, p=.005). Major social change post-MVA (70%) was predicted by older age (OR=.966, p=.003), depressive symptoms (OR=3.71, p<.001) and opiate use (OR=2.00, p=.039). CONCLUSIONS Biomedical factors, including older age, impaired sleep and indicators of widespread central sensitisation, and psychological factors, including stress, anxiety and depression, were the most prominent multivariate associations as statistical predictors of major adverse sequelae contributing to non-recovery for claimants with chronic pain post-MVA.
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Affiliation(s)
- Aidan Christopher Tan
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
| | - Samantha Kate Allen
- Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, NSW, Australia.
| | - Iqra Aziz
- Royal North Shore Hospital, Sydney, NSW, Australia.
| | | | | | - Faisal Syed
- Wollongong Hospital, Sydney, NSW, Australia.
| | - G David Champion
- School of Women's and Children's Health, Department of Pain, University of New South Wales, Sydney, Level 7 Bright Alliance Building, High Street, Randwick, NSW 2031, Australia.
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Germine LT, Joormann J, Passell E, Rutter LA, Scheuer L, Martini P, Hwang I, Lee S, Sampson N, Barch DM, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Linnstaedt SD, Jovanovic T, Clifford GD, Neylan TC, Rauch SL, Lewandowski C, Hendry PL, Sheikh S, Storrow AB, Musey PI, Jones CW, Punches BE, McGrath ME, Pascual JL, Mohiuddin K, Pearson C, Peak DA, Domeier RM, Bruce SE, Rathlev NK, Sanchez LD, Pietrzak RH, Pizzagalli DA, Harte SE, Elliott JM, Koenen KC, Ressler KJ, McLean SA, Kessler RC. Neurocognition after motor vehicle collision and adverse post-traumatic neuropsychiatric sequelae within 8 weeks: Initial findings from the AURORA study. J Affect Disord 2022; 298:57-67. [PMID: 34800569 PMCID: PMC10878171 DOI: 10.1016/j.jad.2021.10.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/14/2021] [Accepted: 10/23/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous work has indicated that differences in neurocognitive functioning may predict the development of adverse post-traumatic neuropsychiatric sequelae (APNS). Such differences may be vulnerability factors or simply correlates of APNS-related symptoms. Longitudinal studies that measure neurocognitive functioning at the time of trauma are needed to determine whether such differences precede the development of APNS. METHODS Here, we present findings from a subsample of 666 ambulatory patients from the AURORA (Advancing Understanding of RecOvery afteR trumA) study. All patients presented to EDs after a motor vehicle collision (MVC). We examined associations of neurocognitive test performance shortly after MVC with peritraumatic symptoms in the ED and APNS (depression, post-traumatic stress, post-concussive symptoms, and pain) 2 weeks and 8 weeks later. Neurocognitive tests assessed processing speed, attention, verbal reasoning, memory, and social perception. RESULTS Distress in the ED was associated with poorer processing speed and short-term memory. Poorer short-term memory was also associated with depression at 2 weeks post-MVC, even after controlling for peritraumatic distress. Finally, higher vocabulary scores were associated with pain 2 weeks post-MVC. LIMITATIONS Self-selection biases among those who present to the ED and enroll in the study limit generalizability. Also, it is not clear whether observed neurocognitive differences predate MVC exposure or arise in the immediate aftermath of MVC exposure. CONCLUSIONS Our results suggest that processing speed and short-term memory may be useful predictors of trauma-related characteristics and the development of some APNS, making such measures clinically-relevant for identifying at-risk individuals.
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Affiliation(s)
- Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; The Many Brains Project, Belmont, MA, USA.
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Eliza Passell
- Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA
| | - Lauren A Rutter
- Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Luke Scheuer
- Institute for Technology in Psychiatry, McLean Hospital, 1010 Pleasant Street, Belmont, MA 02478, USA
| | | | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Sue Lee
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine and Health Services, Policy, and Practice, The Alpert Medical School of Brown University, USA; Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA; Department of Emergency Medicine, The Miriam Hospital, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, USA; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Thomas C Neylan
- San Francisco VA Healthcare System, San Francisco, CA, USA; Departments of Psychiatry, University of California, San Francisco, CA, USA; Departments of Neurology, University of California, San Francisco, CA, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | | | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittney E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
| | - Jose L Pascual
- Department of Surgery and Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kamran Mohiuddin
- Dept. of Emergency Medicine/Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Departments of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA; Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- The Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, St Leonards, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karesten C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety Disorders, McLean hospital, Belmont, MA, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Beaudoin FL, Kessler RC, Hwang I, Lee S, Sampson NA, An X, Ressler KJ, Koenen KC, McLean SA. Pain after a motor vehicle crash: The role of socio-demographics, crash characteristics and peri-traumatic stress symptoms. Eur J Pain 2021; 25:1119-1136. [PMID: 33458880 PMCID: PMC10913946 DOI: 10.1002/ejp.1733] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 01/13/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The vast majority of individuals who come to the emergency department (ED) for care after a motor vehicle collision (MVC) are diagnosed with musculoskeletal strain only and are discharged to home. A significant subset of this population will still develop persistent pain and posttraumatic psychological sequelae may play an important role in pain persistence. METHODS We conducted a multisite longitudinal cohort study of adverse post-traumatic neuropsychiatric sequelae among patients seeking ED treatment in the aftermath of a traumatic life experience. We report on a sub-group of patients (n = 666) presenting after an MVC, the most common type of trauma and we examine associations of socio-demographic and MVC characteristics, and persistent pain 8 weeks after MVC. We also examine the degree to which these associations are related to peritraumatic psychological symptoms and 2-week acute stress reactions using an applied approach. RESULTS Eight-week prevalence of persistent moderate or severe pain was high (67.4%) and positively associated with patient sex (female), older age, low socioeconomic status (education and income) and pain severity in the ED. Peritraumatic stress symptoms (distress and dissociation) appear to exert some influence on both acute pain and the transition from acute to persistent pain. DISCUSSION AND CONCLUSIONS The early aftermath of an MVC may be an important time period for intervening to prevent and reduce persistent pain. Substantial variation in mediating pathways across predictors also suggests potential diverse and complex underlying biological and psychological pathogenic processes are at work in the early weeks following trauma. SIGNIFICANCE The first several days after trauma may dictate recovery trajectories. Persistent pain, pain lasting beyond the expected time of recovery, is associated with pain early in the recovery period, but also mediated through other pathways. Future work is needed to understand the complex neurobiological processes in involved in the development of persistent and acute post-traumatic pain.
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Affiliation(s)
- Francesca L. Beaudoin
- Department of Emergency Medicine & Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - I. Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - S. Lee
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - X. An
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K. J. Ressler
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - K. C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S. A. McLean
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ellingsen DM, Beissner F, Moher Alsady T, Lazaridou A, Paschali M, Berry M, Isaro L, Grahl A, Lee J, Wasan AD, Edwards RR, Napadow V. A picture is worth a thousand words: linking fibromyalgia pain widespreadness from digital pain drawings with pain catastrophizing and brain cross-network connectivity. Pain 2021; 162:1352-1363. [PMID: 33230008 PMCID: PMC8049950 DOI: 10.1097/j.pain.0000000000002134] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/01/2020] [Indexed: 01/08/2023]
Abstract
ABSTRACT Pain catastrophizing is prominent in chronic pain conditions such as fibromyalgia and has been proposed to contribute to the development of pain widespreadness. However, the brain mechanisms responsible for this association are unknown. We hypothesized that increased resting salience network (SLN) connectivity to nodes of the default mode network (DMN), representing previously reported pain-linked cross-network enmeshment, would be associated with increased pain catastrophizing and widespreadness across body sites. We applied functional magnetic resonance imaging (fMRI) and digital pain drawings (free-hand drawing over a body outline, analyzed using conventional software for multivoxel fMRI analysis) to investigate precisely quantified measures of pain widespreadness and the associations between pain catastrophizing (Pain Catastrophizing Scale), resting brain network connectivity (Dual-regression Independent Component Analysis, 6-minute multiband accelerated fMRI), and pain widespreadness in fibromyalgia patients (N = 79). Fibromyalgia patients reported pain in multiple body areas (most frequently the spinal region, from the lower back to the neck), with moderately high pain widespreadness (mean ± SD: 26.1 ± 24.1% of total body area), and high pain catastrophizing scale scores (27.0 ± 21.9, scale range: 0-52), which were positively correlated (r = 0.26, P = 0.02). A whole-brain regression analysis focused on SLN connectivity indicated that pain widespreadness was also positively associated with SLN connectivity to the posterior cingulate cortex, a key node of the DMN. Moreover, we found that SLN-posterior cingulate cortex connectivity statistically mediated the association between pain catastrophizing and pain widespreadness (P = 0.01). In conclusion, we identified a putative brain mechanism underpinning the association between greater pain catastrophizing and a larger spatial extent of body pain in fibromyalgia, implicating a role for brain SLN-DMN cross-network enmeshment in mediating this association.
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Affiliation(s)
- Dan-Mikael Ellingsen
- Department of Psychology, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital, Oslo, Norway
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Florian Beissner
- Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Tawfik Moher Alsady
- Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Asimina Lazaridou
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, United States
| | - Myrella Paschali
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, United States
| | - Michael Berry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Laura Isaro
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, United States
| | - Arvina Grahl
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Jeungchan Lee
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Ajay D Wasan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Robert R Edwards
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, United States
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, United States
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Beaudoin FL, Zhai W, Merchant RC, Clark MA, Kurz MC, Hendry P, Swor RA, Peak D, Pearson C, Domeier R, Ortiz C, McLean SA. Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort Study. West J Emerg Med 2020; 22:139-147. [PMID: 33856293 PMCID: PMC7972399 DOI: 10.5811/westjem.2020.8.47450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/12/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Blacks in the United States experience greater persistent pain than non-Hispanic Whites across a range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factors or incidence of persistent pain among Blacks experiencing common traumatic stress exposures such as after a motor vehicle collision (MVC). We evaluated the incidence and predictors of moderate to severe axial musculoskeletal pain (MSAP) and widespread pain six weeks after a MVC in a large cohort of Black adults presenting to the emergency department (ED) for care. METHODS This prospective, multi-center, cohort study enrolled Black adults who presented to one of 13 EDs across the US within 24 hours of a MVC and were discharged home after their evaluation. Data were collected at the ED visit via patient interview and self-report surveys at six weeks after the ED visit via internet-based, self-report survey, or telephone interview. We assessed MSAP pain at ED visit and persistence at six weeks. Multivariable models examined factors associated with MSAP persistence at six weeks post-MVC. RESULTS Among 787 participants, less than 1% reported no pain in the ED after their MVC, while 79.8 (95% confidence interval [CI], 77.1 - 82.2) reported MSAP and 28.3 (95% CI, 25.5 - 31.3) had widespread pain. At six weeks, 67% (95% CI, 64, 70%) had MSAP and 31% (95% CI, 28, 34%) had widespread pain. ED characteristics predicting MSAP at six weeks post-MVC (area under the curve = 0.74; 95% CI, 0.72, 0.74) were older age, peritraumatic dissociation, moderate to severe pain in the ED, feeling uncertain about recovery, and symptoms of depression. CONCLUSION These data indicate that Blacks presenting to the ED for evaluation after MVCs are at high risk for persistent and widespread musculoskeletal pain. Preventive interventions are needed to improve outcomes for this high-risk group.
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Affiliation(s)
- Francesca L Beaudoin
- Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Wanting Zhai
- Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Roland C Merchant
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Melissa A Clark
- Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Michael C Kurz
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Phyllis Hendry
- University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Robert A Swor
- Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - David Peak
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Claire Pearson
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Robert Domeier
- St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Christine Ortiz
- Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Samuel A McLean
- University of North Carolina - Chapel Hill, Department of Anesthesiology and Emergency Medicine, Chapel Hill, North Carolina.,Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.,St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.,Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island.,University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.,University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida.,Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.,Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
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11
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Galve Villa M, S Palsson T, Cid Royo A, R Bjarkam C, Boudreau SA. Digital Pain Mapping and Tracking in Patients With Chronic Pain: Longitudinal Study. J Med Internet Res 2020; 22:e21475. [PMID: 33104012 PMCID: PMC7652695 DOI: 10.2196/21475] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023] Open
Abstract
Background Digital pain mapping allows for remote and ecological momentary assessment in patients over multiple time points spanning days to months. Frequent ecological assessments may reveal tendencies and fluctuations more clearly and provide insights into the trajectory of a patient’s pain. Objective The primary aim of this study is to remotely map and track the intensity and distribution of pain and discomfort (eg, burning, aching, and tingling) in patients with nonmalignant spinal referred pain over 12 weeks using a web-based app for digital pain mapping. The secondary aim is to explore the barriers of use by determining the differences in clinical and user characteristics between patients with good (regular users) and poor (nonregular users) reporting compliance. Methods Patients (N=91; n=53 women) with spinal referred pain were recruited using web-based and traditional in-house strategies. Patients were asked to submit weekly digital pain reports for 12 weeks. Each pain report consisted of digital pain drawings on a pseudo–three-dimensional body chart and pain intensity ratings. The pain drawings captured the distribution of pain and discomfort (pain quality descriptors) expressed as the total extent and location. Differences in weekly pain reports were explored using the total extent (pixels), current and usual pain intensity ratings, frequency of quality descriptor selection, and Jaccard similarity index. Validated e-questionnaires were completed at baseline to determine the patients’ characteristics (adapted Danish National Spine Register), disability (Oswestry Disability Index and Neck Disability Index), and pain catastrophizing (Pain Catastrophizing Scale) profiles. Barriers of use were assessed at 6 weeks using a health care–related usability and acceptance e-questionnaire and a self-developed technology-specific e-questionnaire to assess the accessibility and ease of access of the pain mapping app. Associations between total extent, pain intensity, disability, and catastrophizing were explored to further understand pain. Differences between regular and nonregular users were assessed to understand the pain mapping app reporting compliance. Results Fluctuations were identified in pain reports for total extent and pain intensity ratings (P<.001). However, quality descriptor selection (P=.99) and pain drawing (P=.49), compared using the Jaccard index, were similar over time. Interestingly, current pain intensity was greater than usual pain intensity (P<.001), suggesting that the timing of pain reporting coincided with a more intense pain experience than usual. Usability and acceptance were similar between regular and nonregular users. Regular users were younger (P<.001) and reported a larger total extent of pain than nonregular users (P<.001). Conclusions This is the first study to examine digital reports of pain intensity and distribution in patients with nonmalignant spinal referred pain remotely for a sustained period and barriers of use and compliance using a digital pain mapping app. Differences in age, pain distribution, and current pain intensity may influence reporting behavior and compliance.
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Affiliation(s)
- Maria Galve Villa
- Center for Neuroplasticity and Pain, Center for Sensory Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Thorvaldur S Palsson
- Center for Sensory Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Albert Cid Royo
- Center for Neuroplasticity and Pain, Center for Sensory Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Carsten R Bjarkam
- Department of Neurosurgery, Institute of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Shellie A Boudreau
- Center for Neuroplasticity and Pain, Center for Sensory Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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12
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Efficacy and Safety of Blood Stasis Based Herbal Medicine for Patients with Traffic Accident : A Prospective Observational Study. JOURNAL OF ACUPUNCTURE RESEARCH 2020. [DOI: 10.13045/jar.2020.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Blood stasis (BS) is commonly used for pattern identification in traumatic injuries, including traffic accidents (TAs). Various studies have identified the efficacy of Korean medicine treatments for TA patients, but studies focusing on the BS-based herbal medicine (BSHM), including Tongdo-san (TDS), are rare.<br/>Methods: This was a single-center, prospective observational study, conducted from August 24th, 2018 to December 27th, 2018, which included 40 TA patients. Participants underwent routine Korean medicine treatments including acupuncture, electronic moxibustion, cupping, physical therapy, and herbal medicine. In the herbal medicine treatment, participants took BSHM with more than 3 days including taking TDS. The primary outcome measures were the scores from a 100 mm visual analogue scale (VAS) and numerical rating scale (NRS). Secondary outcome measures included scores from EuroQol-5 dimension (EQ-5D) and EQVAS questionnaires, the BS and cold/heat indices, and safety assessments.<br/>Results: There were significant improvements in the VAS, NRS, EQ-5D, EQ-VAS scores, and BS index after treatment. In the sub-analysis, VAS, NRS, EQ-5D, and EQ-VAS scores were higher in groups with a higher BS index. The moderate and severe BS index groups showed more improvement than the minor BS index group, and there was a significant difference in the EQ-5D scores. There was no significant differences observed in cold/heat index groups scores.<br/>Conclusion: BS is associated with TA-related symptoms. BSHM, including TDS, may significantly reduce BS, pain, and discomfort.
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13
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Fitzgerald JM, Belleau EL, Ehret LE, Trevino C, Brasel KJ, Larson C, deRoon-Cassini T. DACC Resting State Functional Connectivity as a Predictor of Pain Symptoms Following Motor Vehicle Crash: A Preliminary Investigation. THE JOURNAL OF PAIN 2020; 22:171-179. [PMID: 32736035 DOI: 10.1016/j.jpain.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/26/2020] [Accepted: 07/25/2020] [Indexed: 12/25/2022]
Abstract
There is significant heterogeneity in pain outcomes following motor vehicle crashes (MVCs), such that a sizeable portion of individuals develop symptoms of chronic pain months after injury while others recover. Despite variable outcomes, the pathogenesis of chronic pain is currently unclear. Previous neuroimaging work implicates the dorsal anterior cingulate cortex (dACC) in adaptive control of pain, while prior resting state functional magnetic resonance imaging studies find increased functional connectivity (FC) between the dACC and regions involved in pain processing in those with chronic pain. Hyper-connectivity of the dACC to regions that mediate pain response may therefore relate to pain severity. The present study completed rsfMRI scans on N = 22 survivors of MVCs collected within 2 weeks of the incident to test whole-brain dACC-FC as a predictor of pain severity 6 months later. At 2 weeks, pain symptoms were predicted by positive connectivity between the dACC and the premotor cortex. Controlling for pain symptoms at 2 weeks, pain symptoms at 6 months were predicted by negative connectivity between the dACC and the precuneus. Previous research implicates the precuneus in the individual subjective awareness of pain. Given a relatively small sample size, approximately half of which did not experience chronic pain at 6 months, findings warrant replication. Nevertheless, this study provides preliminary evidence of enhanced dACC connectivity with motor regions and decreased connectivity with pain processing regions as immediate and prospective predictors of pain following MVC. PERSPECTIVE: This article presents evidence of distinct neural vulnerabilities that predict chronic pain in MVC survivors based on whole-brain connectivity with the dorsal anterior cingulate cortex.
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Affiliation(s)
| | - Emily L Belleau
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Colleen Trevino
- Division of Trauma & Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Christine Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Terri deRoon-Cassini
- Division of Trauma & Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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14
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Do post-traumatic pain and post-traumatic stress symptomatology mutually maintain each other? A systematic review of cross-lagged studies. Pain 2019; 159:2159-2169. [PMID: 29994992 DOI: 10.1097/j.pain.0000000000001331] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
After traumatic exposure, individuals are at risk of developing symptoms of both pain and post-traumatic stress disorder (PTSD). Theory and research suggest a complex and potentially mutually maintaining relationship between these symptomatologies. However, findings are inconsistent and the applied methods are not always well suited for testing mutual maintenance. Cross-lagged designs can provide valuable insights into such temporal associations, but there is a need for a systematic review to assist clinicians and researchers in understanding the nature of the relationship. Thus, the aim of this systematic review was to identify, critically appraise, and synthesize results from cross-lagged studies on pain and PTSD symptomatology to assess the evidence for longitudinal reciprocity and potential mediators. Systematic searches resulted in 7 eligible studies that were deemed of acceptable quality with moderate risk of bias using the cohort study checklist from Scottish Intercollegiate Guidelines Network. Furthermore, synthesis of significant pathways in the cross-lagged models showed inconsistent evidence of both bidirectional and unidirectional interaction patterns between pain and PTSD symptomatology across time, hence not uniformly supporting the theoretical framework of mutual maintenance. In addition, the synthesis suggested that hyperarousal and intrusion symptoms may be of particular importance in these cross-lagged relationships, while there was inconclusive evidence of catastrophizing as a mediator. In conclusion, the findings suggest an entangled, but not necessarily mutually maintaining relationship between pain and PTSD symptomatology. However, major variations in findings and methodologies complicated synthesis, prompting careful interpretation and heightening the likelihood that future high-quality studies will change these conclusions.
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15
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Sewell J, Dixon C, Morris R, Stuart S. Anatomical distribution of musculoskeletal disorders following a road traffic collision in litigants presenting to physiotherapists within a private-clinic in North-East England. Physiother Theory Pract 2018; 35:873-883. [PMID: 29659312 DOI: 10.1080/09593985.2018.1459986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Introduction: Musculoskeletal disorders (MSDs) are common following a road traffic collision (RTC) in England. Establishing the anatomical distribution of MSDs following RTC that present to physiotherapists may improve understanding and clinical practice. This study examined anatomical distribution of MSDs that present to physiotherapists within a litigant population following a RTC in England. Methods: A retrospective review of physiotherapy records was conducted at a private practice in North-East England. Data were collected from 2105 patients between January 2014 and December 2015. The primary outcome was anatomical regions with MSDs. Descriptive data is reported. Results: Overall, 90% of patients presented with a neck/upper back disorder, while 52% presented with a lower back disorder. Of the assessed patients, 46% presented with one MSD, 45% presented with two MSDs while 9% presented with ≥3 MSDs. Further analysis showed that those who presented to physiotherapy later and were not motor vehicle occupants (MVOs) were more likely to have upper-limb, lower-limb, or lumbar MSDs. Younger patients, who presented sooner and were non-MVO were more likely to have multiple regions affected by MSDs. Conclusions: This study presents epidemiological evidence that MSDs following a RTC occur primarily in the neck/upper back or lower back regions, and that multiple MSDs are common.
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Affiliation(s)
| | - Cheryl Dixon
- a On Medical Ltd ., Newcastle upon Tyne , England, UK
| | - Rosie Morris
- a On Medical Ltd ., Newcastle upon Tyne , England, UK.,b Institute of Neuroscience/Newcastle University Institute of Ageing , Newcastle University , Newcastle upon Tyne , England, UK
| | - Samuel Stuart
- a On Medical Ltd ., Newcastle upon Tyne , England, UK.,b Institute of Neuroscience/Newcastle University Institute of Ageing , Newcastle University , Newcastle upon Tyne , England, UK
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Persistent pain after motor vehicle collision: comparative effectiveness of opioids vs nonsteroidal antiinflammatory drugs prescribed from the emergency department-a propensity matched analysis. Pain 2017; 158:289-295. [PMID: 28092325 DOI: 10.1097/j.pain.0000000000000756] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Each year millions of Americans present to the emergency department (ED) for care after a motor vehicle collision (MVC); the majority (>90%) are discharged to home after evaluation. Acute musculoskeletal pain is the norm in this population, and such patients are typically discharged to home with prescriptions for oral opioid analgesics or nonsteroidal antiinflammatory drugs (NSAIDs). The influence of acute pain management on subsequent pain outcomes in this common ED population is unknown. We evaluated the effect of opioid analgesics vs NSAIDs initiated from the ED on the presence of moderate to severe musculoskeletal pain and ongoing opioid use at 6 weeks in a large cohort of adult ED patients presenting to the ED after MVC (n = 948). The effect of opioids vs NSAIDs was evaluated using an innovative quasi-experimental design method using propensity scores to account for covariate imbalances between the 2 treatment groups. No difference in risk for moderate to severe musculoskeletal pain at 6 weeks was observed between those discharged with opioid analgesics vs NSAIDs (risk difference = 7.2% [95% confidence interval: -5.2% to 19.5%]). However, at follow-up participants prescribed opioids were more likely than those prescribed NSAIDs to report use of prescription opioids medications at week 6 (risk difference = 17.5% [95% confidence interval: 5.8%-29.3%]). These results suggest that analgesic choice at ED discharge does not influence the development of persistent moderate to severe musculoskeletal pain 6 weeks after an MVC, but may result in continued use of prescription opioids. Supported by NIAMS R01AR056328 and AHRQ 5K12HS022998.
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17
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Westergren H, Larsson J, Freeman M, Carlsson A, Jöud A, Malmström EM. Sex-based differences in pain distribution in a cohort of patients with persistent post-traumatic neck pain. Disabil Rehabil 2017; 40:1085-1091. [DOI: 10.1080/09638288.2017.1280543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Hans Westergren
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Johan Larsson
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Michael Freeman
- Department of Psychiatry, Oregon Health & Science University School of Medicine, Portland, OR, USA
- School for Public Health and Primary Care CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anna Carlsson
- Chalmers Industrial Technology (CIT), Gothenburg, Sweden
| | - Anna Jöud
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden
| | - Eva-Maj Malmström
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Otorhinolaryngology, Clinical Sciences, Lund University, Lund, Sweden
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Kreinest M, Scholz M, Trafford P. On-scene treatment of spinal injuries in motor sports. Eur J Trauma Emerg Surg 2016; 43:191-200. [PMID: 28005155 DOI: 10.1007/s00068-016-0749-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/12/2016] [Indexed: 12/18/2022]
Abstract
Because spinal cord injuries can have fatal consequences for injured race car drivers, prehospital treatment of spinal injuries is a major concern in motor sports. A structured procedure for assessing trauma patients and their treatment should follow established ABCDE principles. Only then, a stable patient could be further examined and appropriate measures can be undertaken. For patients in an acute life-threatening condition, rapid transport must be initiated and should not be delayed by measures that are not indicated. If a competitor must first be extricated from the racing vehicle, the correct method of extrication must be chosen. To avoid secondary injury to the spine after a racing accident, in-line extrication from the vehicle and immobilization of the patient are standard procedures in motor sports and have been used for decades. Since immobilization can be associated with disadvantages and complications, the need for immobilization of trauma patients outside of motor sports medicine has become the subject of an increasing number of reports in the scientific literature. Even in motor sports, where specific safety systems that offer spinal protection are present, the indications for spinal immobilization need to be carefully considered rather than being blindly adopted as a matter of course. The aim of this article is to use recent literature to present an overview about the treatment of spinal injuries in motor sports. Further, we present a new protocol for indications for immobilizing the spine in motor sports that is based on the ABCDE principles and takes into account the condition of the patient.
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Affiliation(s)
- M Kreinest
- Department for Trauma Surgery, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
| | - M Scholz
- Department for Orthopedics and Anesthesia, Specialty Hospital Vogelsang-Gommern, Sophie-v.-Boetticher-Straße 1, 39245, Gommern, Germany
| | - P Trafford
- Department of Anesthesia, Arrowe Park Hospital, Arrowe Park Road, Upton, United Kingdom
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19
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Genetic predictors of human chronic pain conditions. Neuroscience 2016; 338:36-62. [DOI: 10.1016/j.neuroscience.2016.04.041] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/15/2016] [Accepted: 04/25/2016] [Indexed: 11/15/2022]
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Kreinest M, Gliwitzky B, Grützner PA, Münzberg M. Untersuchung der Anwendbarkeit eines neuen Protokolls zur Immobilisation der Wirbelsäule. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0154-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Kreinest M, Gliwitzky B, Schüler S, Grützner PA, Münzberg M. Development of a new Emergency Medicine Spinal Immobilization Protocol for trauma patients and a test of applicability by German emergency care providers. Scand J Trauma Resusc Emerg Med 2016; 24:71. [PMID: 27180045 PMCID: PMC4867978 DOI: 10.1186/s13049-016-0267-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/10/2016] [Indexed: 12/24/2022] Open
Abstract
Background In order to match the challenges of quickly recognizing and treating any life-threatening injuries, the ABCDE principles were established for the assessment and treatment of trauma patients. The high priority of spine protection is emphasized by the fact that immobilization of the cervical spine is performed at the very first step in the ABCDE principles. Immobilization is typically performed to prevent or minimize secondary damage to the spinal cord if instability of the spinal column is suspected. Due to increasing reports about disadvantages of spinal immobilization, the indications for performing spinal immobilization must be refined. The aim of this study was (i) to develop a protocol that supports decision-making for spinal immobilization in adult trauma patients and (ii) to carry out the first applicability test by emergency medical personnel. Methods A structured literature search considering the literature from 1980 to 2014 was performed. Based on this literature and on the current guidelines, a new protocol that supports on scene decision-making for spinal immobilization has been developed. Parameters found in the literature concerning mechanisms and factors increasing the likelihood of spinal injury have been included in the new protocol. In order to test the applicability of the new protocol two surveys were performed on German emergency care providers by means of a questionnaire focused on correct decision-making if applying the protocol. Results Based on the current literature and guidelines, the Emergency Medicine Spinal Immobilization Protocol (E.M.S. IMMO Protocol) for adult trauma patients was developed. Following a fist applicability test involving 21 participants, the first version of the E.M.S. IMMO Protocol has to be graphically re-organized. A second applicability test comprised 50 participants with the current version of the protocol confirmed good applicability. Questions regarding immobilization of trauma patients could be answered properly using the E.M.S. IMMO Protocol. Discussion Current literature increasingly reports of disadvantages that may be associated with immobilization. Based on the requirements of the current guidelines, a new protocol that supports decision-making for indications for out-of-hospital spinal immobilization has been developed in this study. In contrast to established protocols, the new protocol offers different options for immobilization as well as a decicion-support. Conclusions The E.M.S. IMMO protocol provides a decision-support tool for indications for spinal immobilization in adult trauma patients that permits variable decision-making depending on the current condition of the trauma patient and the pattern of injuries for immobilization in general and for immobilization method in particular.
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Affiliation(s)
- Michael Kreinest
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.,PHTLS Europe Research Group, Offenbach/Queich, Germany
| | | | - Svenja Schüler
- University of Heidelberg, Institute for Medical Biometry and Informatics, Heidelberg, Germany
| | - Paul A Grützner
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Matthias Münzberg
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany. .,PHTLS Europe Research Group, Offenbach/Queich, Germany.
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22
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Sutton DA, Nordin M, Côté P, Randhawa K, Yu H, Wong JJ, Stern P, Varatharajan S, Southerst D, Shearer HM, Stupar M, Chung C, Goldgrub R, Carroll LJ, Taylor-Vaisey A. The Effectiveness of Multimodal Care for Soft Tissue Injuries of the Lower Extremity: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. J Manipulative Physiol Ther 2016; 39:95-109.e2. [DOI: 10.1016/j.jmpt.2016.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/30/2015] [Accepted: 10/13/2015] [Indexed: 12/26/2022]
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Hu J, Bortsov AV, Ballina L, Orrey DC, Swor RA, Peak D, Jones J, Rathlev N, Lee DC, Domeier R, Hendry P, Parry BA, McLean SA. Chronic widespread pain after motor vehicle collision typically occurs through immediate development and nonrecovery: results of an emergency department-based cohort study. Pain 2016; 157:438-444. [PMID: 26808013 PMCID: PMC4942849 DOI: 10.1097/j.pain.0000000000000388] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Motor vehicle collision (MVC) can trigger chronic widespread pain (CWP) development in vulnerable individuals. Whether such CWP typically develops through the evolution of pain from regional to widespread or through the early development of widespread pain with nonrecovery is currently unknown. We evaluated the trajectory of CWP development (American College of Rheumatology criteria) among 948 European-American individuals who presented to the emergency department (ED) for care in the early aftermath of MVC. Pain extent was assessed in the ED and 6 weeks, 6 months, and 1 year after MVC on 100%, 91%, 89%, and 91% of participants, respectively. Individuals who reported prior CWP at the time of ED evaluation (n = 53) were excluded. Trajectory modeling identified a 2-group solution as optimal, with the Bayes Factor value (138) indicating strong model selection. Linear solution plots supported a nonrecovery model. Although the number of body regions with pain in the non-CWP group steadily declined, the number of body regions with pain in the CWP trajectory group (192/895, 22%) remained relatively constant over time. These data support the hypothesis that individuals who develop CWP after MVC develop widespread pain in the early aftermath of MVC, which does not remit.
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Affiliation(s)
- JunMei Hu
- TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC, USA Anesthesiology, University of North Carolina, Chapel Hill, NC, USA Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA Emergency Medicine, Spectrum Health System, Grand Rapids, MI, USA Emergency Medicine, Baystate Medical Center, Springfield, MA, USA Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA Emergency Medicine, Saint Joseph Mercy Health System, Ypsilanti, MI, USA Emergency Medicine, University of Florida, Jacksonville, FL, USA Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
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24
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Niederstrasser NG, Meulders A, Meulders M, Slepian PM, Vlaeyen JW, Sullivan MJ. Pain Catastrophizing and Fear of Pain Predict the Experience of Pain in Body Parts Not Targeted by a Delayed-Onset Muscle Soreness Procedure. THE JOURNAL OF PAIN 2015; 16:1065-76. [DOI: 10.1016/j.jpain.2015.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/07/2015] [Accepted: 07/29/2015] [Indexed: 01/07/2023]
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25
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Qadri YJ, Bortsov AV, Orrey DC, Swor RA, Peak DA, Jones JS, Rathlev NK, Lee DC, Domeier RM, Hendry PL, Mclean SA. Genetic Polymorphisms in the Dopamine Receptor 2 Predict Acute Pain Severity After Motor Vehicle Collision. Clin J Pain 2015; 31:768-775. [PMID: 25370144 PMCID: PMC4417662 DOI: 10.1097/ajp.0000000000000167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Dopaminergic signaling is implicated in nociceptive pathways. These effects are mediated largely through dopamine receptors and modulated in part by dopamine transporters. This study tested the hypothesis that genetic variants in the genes encoding dopamine receptor 2 (DRD2) and the dopamine active transporter (SLC6A3) influence acute pain severity after motor vehicle collision. MATERIALS AND METHODS European Americans presenting to the emergency department after motor vehicle collision were recruited. Overall pain intensity in emergency department was assessed using a 0 to 10 numeric rating scale. DNA was extracted from blood samples and genotyping of single-nucleotide polymorphisms (SNPs) in the DRD2 and SLC6A3 gene was performed. RESULTS A total of 948 patients completed evaluation. After correction for multiple comparisons, SNP rs6276 at DRD2 showed significant association with pain scores, with individuals with the A/A genotype reporting lower mean pain scores (5.3; 95% confidence interval [CI], 5.1-5.5) than those with A/G (5.9; 95% CI, 5.6-6.1) or G/G (5.7; 95% CI, 5.2-6.2) genotypes (P=0.0027). Secondary analyses revealed an interaction between sex and DRD2 SNPs rs4586205 and rs4648318 on pain scores: females with 2 minor alleles had increased pain intensity, whereas males with 2 minor alleles had less pain than individuals with a major allele (interaction P=0.0019). DISCUSSION Genetic variants in DRD2 are associated with acute pain after a traumatic stressful event. These results suggest that dopaminergic agents may be useful for the treatment of individuals with acute posttraumatic pain as part of a multimodal opioid-sparing analgesic regimen.
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Affiliation(s)
- Yawar J Qadri
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Andrey V Bortsov
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Danielle C Orrey
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Robert A Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Jeffrey S Jones
- Department of Emergency Medicine, Spectrum Health System, Grand Rapids
| | - Niels K Rathlev
- Department of Emergency Medicine, Bay State Medical Center, Springfield, MA
| | - David C Lee
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Health System, Ypsilanti, MI
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida, Jacksonville, FL
| | - Samuel A Mclean
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
- Department of Emergency Medicine, University of Florida, Jacksonville, FL
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26
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Johansson MS, Boyle E, Hartvigsen J, Jensen Stochkendahl M, Carroll L, Cassidy JD. A population-based, incidence cohort study of mid-back pain after traffic collisions: Factors associated with global recovery. Eur J Pain 2015; 19:1486-95. [PMID: 25690804 PMCID: PMC5024043 DOI: 10.1002/ejp.681] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 01/22/2023]
Abstract
Background Traffic collisions often result in a wide range of symptoms included in the umbrella term whiplash‐associated disorders. Mid‐back pain (MBP) is one of these symptoms. The incidence and prognosis of different traffic injuries and their related conditions (e.g. neck pain, low back pain, depression or others) has been investigated previously; however, knowledge about traffic collision‐related MBP is lacking. The study objectives were to describe the incidence, course of recovery and prognosis of MBP after traffic collisions, in terms of global self‐reported recovery. Methods Longitudinal data from a population‐based inception cohort of all traffic injuries occurring in Saskatchewan, Canada, during a 2‐year period were used. Annual overall and age‐sex‐specific incidence rates were calculated, the course of recovery was described using the Kaplan–Meier technique, and associations between participant characteristics and time‐to‐self‐reported recovery were explored in 3496 MBP cases using Cox proportional hazards models. Results The yearly incidence rate was 236 per 100,000 population during the study period, and was highest in women and in young persons. The median time‐to‐first reported recovery was 101 days (95% CI: 99–104) and about 23% were still not recovered after 1 year. Participant's expectation for recovery, general health, extent of severely affecting comorbidities and having experienced a previous traffic injury were some of the prognostic factors identified. Conclusions These findings show that MBP is common after traffic collisions, may result in a long recovery process and that a range of biopsychosocial factors are associated with recovery.
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Affiliation(s)
- M S Johansson
- Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - E Boyle
- Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - J Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | | | - L Carroll
- School of Public Health and the Alberta Centre for Injury Control and Research, University of Alberta, Edmonton, AB, Canada
| | - J D Cassidy
- Department of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, ON, Canada.,Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada
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27
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Pereira GF, McLean SA, Tkacik TJ, Swor RA, Jones JS, Lee DC, Peak DA, Domeier RM, Rathlev NK, Hendry PL, Platts-Mills TF. Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision. BMC Emerg Med 2014; 14:25. [PMID: 25547869 PMCID: PMC4307167 DOI: 10.1186/s12873-014-0025-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/09/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Motor vehicle collisions (MVCs) are the second most common injury mechanism resulting in emergency department (ED) visits by older adults. MVCs result in substantial pain and psychological distress among younger individuals, but little is known about the occurrence of these symptoms in older individuals. We describe the frequency of and characteristics associated with pain, distress, and anticipated time for physical and emotional recovery for older adults presenting to the ED after MVC in comparison to younger adults. METHODS In-person interviews were conducted for adults presenting to one of eight EDs after MVC without an obvious fracture or injury requiring admission as part of two prospective studies. Pain severity was assessed using a 0-10 verbal scale. Distress was assessed using the Peritraumatic Distress Inventory (range 0-52). Patients were asked to estimate their expected time for physical and emotional recovery; these responses were dichotomized to <30 or ≥30 days. ED pain and distress and associations between patient and collision characteristics and ED pain and distress were examined for patients age 65 years and older and patients age 18 to 64. RESULTS Older (n = 96) and younger (n = 943) adults had the same mean pain scores (5.5, SD 2.5 vs. 5.5, SD 2.4). Distress scores were lower in older than in younger adults (15.5, SD 9 vs. 19.2, SD 10). A higher percentage of older adults than younger adults had an anticipated time to physical recovery ≥30 days (41%, 95% confidence interval [CI] 28%-55% vs. 11%, 95% CI 9%-13%). Similarly, older adults were more likely to have an anticipated time for emotional recovery ≥30 days (45%, 95% CI 35%-55% vs. 17%, 95% CI 15%-20%). Older adults were less likely than younger adults to have moderate or severe neck pain (score ≥4) (25%, 95% CI 23% to 41% vs. 54%, 95% CI 48% to 60%) or back pain (31%, 95% CI 23% to 46% vs. 56%, 95% CI 51 to 62%) but more likely to have moderate or severe chest pain (42%, 95% CI 32% to 50% vs. 20%, 95% CI 16 to 23%). Pre-MVC depressive symptoms and pain catastrophizing were positively associated with pain and distress in both older and younger adults. CONCLUSIONS In our cohort, older adults who presented to the ED after MVC experienced similar pain severity as younger patients and less distress but were more likely to estimate their times for physical and emotional recovery to be 30 days or more. Increased emergency provider awareness of acute pain and distress symptoms among older patients experiencing MVC may improve outcomes for these patients.
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Affiliation(s)
- Gregory F Pereira
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
- Departments of Emergency Medicine and Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
| | - Thomas J Tkacik
- Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
| | - Robert A Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
| | - Jeffrey S Jones
- Department of Emergency Medicine, Spectrum Health - Butterworth Campus, Grand Rapids, MI, USA.
| | - David C Lee
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA.
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Robert M Domeier
- Department of Emergency Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI, USA.
| | - Niels K Rathlev
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA.
| | - Phyllis L Hendry
- Department of Emergency Medicine and Pediatrics, University of Florida-Jacksonville, Jacksonville, FL, USA.
| | - Timothy F Platts-Mills
- Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
- Departments of Emergency Medicine and Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
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28
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Niederstrasser NG, Slepian PM, Mankovsky-Arnold T, Larivière C, Vlaeyen JW, Sullivan MJ. An Experimental Approach to Examining Psychological Contributions to Multisite Musculoskeletal Pain. THE JOURNAL OF PAIN 2014; 15:1156-1165. [DOI: 10.1016/j.jpain.2014.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/13/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
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29
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Macintyre PE, Huxtable CA, Flint SLP, Dobbin MDH. Costs and Consequences: A Review of Discharge Opioid Prescribing for ongoing Management of Acute Pain. Anaesth Intensive Care 2014; 42:558-74. [DOI: 10.1177/0310057x1404200504] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over recent years there has been a growing need for patients to be sent home from hospital with prescribed opioids for ongoing management of their acute pain. Increasingly complex surgery is being performed on a day-stay or 23-hour-stay basis and inpatients after major surgery and trauma are now discharged at a much earlier stage than in the past. However, prescription of opioids to be self-administered at home is not without risk. In addition to the potential for acute adverse effects, including opioid-induced ventilatory impairment and impairment of driving skills, a review of the literature shows that opioid use continues in some patients for some years after surgery. There are also indications that over-prescription of discharge opioids occur with a significant amount not consumed, resulting in a potentially large pool of unused opioid available for later use by either the patient or others in the community. Concerns about the potential for harm arising from prescription of opioids for ongoing acute pain management after discharge are relatively recent. However, at a time when serious problems resulting from the non-medical use of opioids have reached epidemic proportions in the community, all doctors must be aware of the potential risks and be able to identify and appropriately manage patients where there might be a risk of prolonged opioid use or misuse. Anaesthetists are ideally placed to exercise stewardship over the use of opioids, so that these drugs can maintain their rightful place in the post-discharge analgesic pharmacopoeia.
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Affiliation(s)
- P. E. Macintyre
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, South Australia
- Acute Pain Service, Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia
| | - C. A. Huxtable
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, South Australia
| | - S. L. P. Flint
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, South Australia
- Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, South Australia
| | - M. D. H. Dobbin
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, South Australia
- Department of Forensic Medicine, Monash University, Melbourne, Victoria
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30
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Bortsov AV, Platts-Mills TF, Peak DA, Jones JS, Swor RA, Domeier RM, Lee DC, Rathlev NK, Hendry PL, Fillingim RB, McLean SA. Effect of pain location and duration on life function in the year after motor vehicle collision. Pain 2014; 155:1836-1845. [PMID: 24972071 DOI: 10.1016/j.pain.2014.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 06/16/2014] [Accepted: 06/19/2014] [Indexed: 02/07/2023]
Abstract
Persistent musculoskeletal pain is common after motor vehicle collision (MVC) and often results in substantial disability. The objective of this study was to identify distributions of post-MVC pain that most interfere with specific life functions and that have the greatest interference with aggregate life function. Study data were obtained from a prospective longitudinal multicenter emergency department-based cohort of 948 European Americans experiencing MVC. Overall pain (0-10 numeric rating scale [NRS]), pain in each of 20 body regions (0-10 NRS), and pain interference (Brief Pain Inventory, 0-10 NRS) were assessed 6 weeks, 6 months, and 1 year after MVC. After adjustment for overall pain intensity, an axial distribution of pain caused the greatest interference with most specific life functions (R(2)=0.15-0.28, association P values of <.001) and with overall function. Axial pain explained more than twice as much variance in pain interference as other pain distributions. However, not all patients with axial pain had neck pain. Moderate or severe low back pain was as common as neck pain at week 6 (prevalence 37% for each) and overlapped with neck pain in only 23% of patients. Further, pain across all body regions accounted for nearly twice as much of the variance in pain interference as neck pain alone (60% vs 34%). These findings suggest that studies of post-MVC pain should not focus on neck pain alone.
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Affiliation(s)
- Andrey V Bortsov
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA Department of Emergency Medicine, Spectrum Health Hospital-Butterworth Campus, Grand Rapids, MI, USA Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA Department of Emergency Medicine, St Joseph Mercy Hospital, Ann Arbor, MI, USA Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA Department of Emergency Medicine, College of Medicine, University of Florida and Shands Jacksonville, Jacksonville, FL, USA Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
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31
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McLean SA, Ulirsch JC, Slade GD, Soward AC, Swor RA, Peak DA, Jones JS, Rathlev NK, Lee DC, Domeier RM, Hendry PL, Bortsov AV, Bair E. Incidence and predictors of neck and widespread pain after motor vehicle collision among US litigants and nonlitigants. Pain 2014; 155:309-321. [PMID: 24145211 PMCID: PMC3902045 DOI: 10.1016/j.pain.2013.10.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 09/11/2013] [Accepted: 10/15/2013] [Indexed: 11/22/2022]
Abstract
Debate continues regarding the influence of litigation on pain outcomes after motor vehicle collision (MVC). In this study we enrolled European Americans presenting to the emergency department (ED) in the hours after MVC (n=948). Six weeks later, participants were interviewed regarding pain symptoms and asked about their participation in MVC-related litigation. The incidence and predictors of neck pain and widespread pain 6weeks after MVC were compared among those engaged in litigation (litigants) and those not engaged in litigation (nonlitigants). Among the 859 of 948 (91%) participants completing 6-week follow-up, 711 of 849 (83%) were nonlitigants. Compared to nonlitigants, litigants were less educated and had more severe neck pain and overall pain, and a greater extent of pain at the time of ED evaluation. Among individuals not engaged in litigation, persistent pain 6weeks after MVC was common: 199 of 711 (28%) had moderate or severe neck pain, 92 of 711 (13%) had widespread pain, and 29 of 711 (4%) had fibromyalgia-like symptoms. Incidence of all 3 outcomes was significantly higher among litigants. Initial pain severity in the ED predicted pain outcomes among both litigants and nonlitigants. Markers of socioeconomic disadvantage predicted worse pain outcomes in litigants but not nonlitigants, and individual pain and psychological symptoms were less predictive of pain outcomes among those engaged in litigation. These data demonstrate that persistent pain after MVC is common among those not engaged in litigation, and provide evidence for bidirectional influences between pain outcomes and litigation after MVC.
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Affiliation(s)
- Samuel A McLean
- TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC, USA Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA School of Dentistry, University of North Carolina, Chapel Hill, NC, USA Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA Department of Emergency Medicine, Spectrum Health System, Grand Rapids, MI, USA Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA Department of Emergency Medicine, Saint Joseph Mercy Health System, Ypsilanti, MI, USA Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA
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