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Platts-Mills TF, McLean SA, Weinberger M, Stearns SC, Bush M, Teresi BB, Hurka-Richardson K, Kroenke K, Kerns RD, Weaver MA, Keefe FJ. Brief educational video plus telecare to enhance recovery for older emergency department patients with acute musculoskeletal pain: study protocol for the BETTER randomized controlled trial. Trials 2020; 21:615. [PMID: 32631400 PMCID: PMC7336469 DOI: 10.1186/s13063-020-04552-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain (MSP) affects more than 40% of adults aged 50 years and older and is the leading cause of disability in the USA. Older adults with chronic MSP are at risk for analgesic-related side effects, long-term opioid use, and functional decline. Recognizing the burden of chronic MSP, reducing the transition from acute to chronic pain is a public health priority. In this paper, we report the protocol for the Brief EducaTional Tool to Enhance Recovery (BETTER) trial. This trial compares two versions of an intervention to usual care for preventing the transition from acute to chronic MSP among older adults in the emergency department (ED). METHODS Three hundred sixty patients from the ED will be randomized to one of three arms: full intervention (an interactive educational video about pain medications and recovery-promoting behaviors, a telecare phone call from a nurse 48 to 72 h after discharge from the ED, and an electronic communication containing clinical information to the patient's primary care provider); video-only intervention (the interactive educational video but no telecare or primary care provider communication); or usual care. Data collection will occur at baseline and at 1 week and 1, 3, 6, and 12 months after study enrollment. The primary outcome is a composite measure of pain severity and interference. Secondary outcomes include physical function, overall health, opioid use, healthcare utilization, and an assessment of the economic value of the intervention. DISCUSSION This trial is the first patient-facing ED-based intervention aimed at helping older adults to better manage their MSP and reduce their risk of developing chronic pain. If effective, future studies will examine the effectiveness of implementation strategies. TRIAL REGISTRATION ClinicalTrials.gov NCT04118595 . Registered on 8 October 2019.
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Affiliation(s)
- Timothy F. Platts-Mills
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Samuel A. McLean
- Department of Anesthesiology, University of North Carolina Hospitals, Chapel Hill, NC USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Sally C. Stearns
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Montika Bush
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Brittni B. Teresi
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Kurt Kroenke
- Regenstrief Institute and Department of Medicine, Indiana University, Indianapolis, IN USA
| | | | - Mark A. Weaver
- Department of Mathematics and Statistics, Elon University, Elon, NC USA
| | - Francis J. Keefe
- Department of Psychology and Neuroscience, Duke University, Durham, NC USA
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Pozzato I, Craig A, Gopinath B, Kifley A, Tran Y, Jagnoor J, Cameron ID. Outcomes after traffic injury: mental health comorbidity and relationship with pain interference. BMC Psychiatry 2020; 20:189. [PMID: 32345257 PMCID: PMC7189452 DOI: 10.1186/s12888-020-02601-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 04/13/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Mental health symptoms, like depressive mood (DM) and post-traumatic stress (PTS), and pain interference (PI) with daily functioning often co-occur following traffic injury and their comorbidity can complicate recovery. This study aimed to map the course and overlapping trajectories of mental health symptoms, and associations with PI in a traffic injury population. METHODS In total, 2019 adults sustaining minor-to-moderate traffic injury were recruited within 28 days post-injury and assessed using phone interviews at 1, 6 and 12-months post-injury. Trajectories of DM, PTS and PI were established and relationships between DM, PTS and PI trajectories were explored using dual trajectory modelling. Bio-psychosocial predictors (e.g. pre-injury health, catastrophizing, acute distress, quality of life, social support) of mental health trajectories were investigated. RESULTS Up to five typical post-trauma trajectories were identified for DM, PTS and PI. Most people were in a resilient mental health trajectory (over 60%, DM or PTS), or in a chronic PI trajectory (almost 60%) 12 months post-injury. While recovery/resilient mental health trajectories were strongly interrelated (73.4% joint probability and > 94% conditional probabilities), DM/PTS comorbidity in chronic trajectories was not straightforward, suggesting a possibly asymmetric relationship. That is, persistent DM was more likely associated with persistent PTS (90.4%), than vice versa (31.9%), with a 22.5% probability that persistent PTS was associated with none or milder depression (i.e. following a recovery/resilient DM trajectory). An asymmetrical relationship was also found between mental health and PI. The majority of those with persistent PI were likely to be in a recovery/resilient DM/PTS trajectory (almost 70%), but those in a non-resilient DM/PTS trajectory showed a high risk of persistent PI. Predictors of non-resilient mental health trajectories included poorer pre-injury health and social support, and shared factors like acute psychological distress and pain catastrophizing. CONCLUSIONS Strong interrelations were confirmed between mental health symptoms and PI following traffic injury. However, persistent DM was more strongly linked to persistent PTS, than vice versa. Persistent PI was only linked with persistent DM/PTS in vulnerable subgroups. Early psychiatric/psychological interventions should target elevated psychological distress and negative appraisals in vulnerable individuals, to reduce long-term mental health morbidity/comorbidity and PI. TRIAL REGISTRATION ACTRN12613000889752.
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Affiliation(s)
- I. Pozzato
- grid.1013.30000 0004 1936 834XJohn Walsh Centre for Rehabilitation Research, Northern Clinical School, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Corner Reserve Road & Westbourne Street, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - A. Craig
- grid.1013.30000 0004 1936 834XJohn Walsh Centre for Rehabilitation Research, Northern Clinical School, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Corner Reserve Road & Westbourne Street, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - B. Gopinath
- grid.1013.30000 0004 1936 834XJohn Walsh Centre for Rehabilitation Research, Northern Clinical School, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Corner Reserve Road & Westbourne Street, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - A. Kifley
- grid.1013.30000 0004 1936 834XJohn Walsh Centre for Rehabilitation Research, Northern Clinical School, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Corner Reserve Road & Westbourne Street, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - Y. Tran
- grid.1004.50000 0001 2158 5405Centre of Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109 Australia
| | - J. Jagnoor
- grid.1013.30000 0004 1936 834XJohn Walsh Centre for Rehabilitation Research, Northern Clinical School, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Corner Reserve Road & Westbourne Street, Royal North Shore Hospital, St Leonards, NSW 2065 Australia ,grid.1005.40000 0004 4902 0432The George Institute for Global Health, The University of NSW, Sydney, Australia
| | - I. D. Cameron
- grid.1013.30000 0004 1936 834XJohn Walsh Centre for Rehabilitation Research, Northern Clinical School, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Corner Reserve Road & Westbourne Street, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
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Platts-Mills TF, Hollowell AG, Burke GF, Zimmerman S, Dayaa JA, Quigley BR, Bush M, Weinberger M, Weaver MA. Randomized controlled pilot study of an educational video plus telecare for the early outpatient management of musculoskeletal pain among older emergency department patients. Trials 2018; 19:10. [PMID: 29304831 PMCID: PMC5756407 DOI: 10.1186/s13063-017-2403-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/11/2017] [Indexed: 02/01/2023] Open
Abstract
Background Musculoskeletal pain is a common reason for emergency department (ED) visits. Following discharge from the ED, patients, particularly older patients, often have difficulty controlling their pain and managing analgesic side effects. We conducted a pilot study of an educational video about pain management with and without follow-up telephone support for older adults presenting to the ED with musculoskeletal pain. Methods ED patients aged 50 years and older with musculoskeletal pain were randomized to: (1) usual care, (2) a brief educational video only, or (3) a brief educational video plus a protocol-guided follow-up telephone call from a physician 48–72 hours after discharge (telecare). The primary outcome was the change from the average pain severity before the ED visit to the average pain severity during the past week assessed one month after the ED visit. Pain was assessed using a 0–10 numerical rating scale. Results Of 75 patients randomized (mean age 64 years), 57 (76%) completed follow up at one month. Of the 18 patients lost to follow up, 12 (67%) had non-working phone numbers. Among patients randomized to the video (arms 2 and 3), 46/50 viewed the entire video; among the 25 patients randomized to the video plus telecare (arm 3), 23 were reached for telecare. Baseline pain scores for the usual care, video, and video plus telecare groups were 7.3, 7.1, and 7.5. At one month, pain scores were 5.8, 4.9, and 4.5, corresponding to average decreases in pain of -1.5, -2.2, and -3.0, respectively. In the pairwise comparison between intervention groups, the video plus telecare group had a 1.7-point (95% CI 1.2, 2.1) greater decrease in pain compared to usual care, and the video group had a 1.1-point (95% CI 0.6, 1.6) greater decrease in pain compared to usual care after adjustment for baseline pain, age, and gender. At one month, clinically important differences were also observed between the video plus telecare and usual care groups for analgesic side effects, ongoing opioid use, and physical function. Conclusion Results of this pilot trial suggest the potential value of an educational video plus telecare to improve outcomes for older adults presenting to the ED with musculoskeletal pain. Changes to the protocol are identified to increase retention for assessment of outcomes. Trials registration ClinicalTrials.gov, NCT02438384. Registered on 5 May 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2403-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Timothy F Platts-Mills
- Department of Emergency Medicine and Division of Geriatrics, Department of Medicine, University of North Carolina Chapel Hill, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
| | - Allison G Hollowell
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gary F Burke
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheryl Zimmerman
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph A Dayaa
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin R Quigley
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Montika Bush
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Morris Weinberger
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark A Weaver
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Platts-Mills TF, Nicholson RJ, Richmond NL, Patel KV, Simonsick EM, Domeier RM, Swor RA, Hendry PL, Peak DA, Rathlev NK, Jones JS, Lee DC, Weaver MA, Keefe FJ, McLean SA. Restricted activity and persistent pain following motor vehicle collision among older adults: a multicenter prospective cohort study. BMC Geriatr 2016; 16:86. [PMID: 27094038 PMCID: PMC4837524 DOI: 10.1186/s12877-016-0260-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/13/2016] [Indexed: 11/17/2022] Open
Abstract
Background Restricted physical activity commonly occurs following acute musculoskeletal pain in older adults and may influence long-term outcomes. We sought to examine the relationship between restricted physical activity after motor vehicle collision (MVC) and the development of persistent pain. Methods We examined data from a prospective study of adults ≥65 years of age presenting to the emergency department (ED) after MVC without life-threatening injuries. Restricted physical activity 6 weeks after MVC was defined in three different ways: 1) by a ≥25 point decrease in Physical Activity Scale in the Elderly (PASE) score, 2) by the answer “yes” to the question, “during the past two weeks, have you stayed in bed for at least half a day?”, and 3) by the answer “yes” to the question, “during the past two weeks, have you cut down on your usual activities as compared to before the accident?” We examined relationships between each definition of restricted activity and pain severity, pain interference, and functional capacity at 6 months with adjustment for confounders. Results Within the study sample (N = 164), adjusted average pain severity scores at 6 months did not differ between patients with and without restricted physical activity based on decreased PASE score (2.54 vs. 2.07, p = 0.32). In contrast, clinically and statistically important differences in adjusted average pain severity at 6 months were observed for patients who reported spending half a day in bed vs. those who did not (3.56 vs. 1.91, p < 0.01). In adjusted analyses, both decreased PASE score and cutting down on activity were associated with functional capacity at 6 months, but only decreased PASE score was associated with increased ADL difficulty at 6 months (0.70 vs. -0.01, p = 0.02). Conclusions Among older adults experiencing MVC, those reporting bed rest or reduced activity 6 weeks after the collision reported higher pain and pain interference scores at 6 months. More research is needed to determine if interventions to promote activity can improve outcomes after MVC in older adults.
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Affiliation(s)
- Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina, 170 Manning Dr, Chapel Hill, NC, USA.
| | - Robert J Nicholson
- Department of Emergency Medicine, University of North Carolina, 170 Manning Dr, Chapel Hill, NC, USA
| | - Natalie L Richmond
- Department of Emergency Medicine, University of North Carolina, 170 Manning Dr, Chapel Hill, NC, USA
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, 251 Bayview Boulevard, Suite 100, Baltimore, MD, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Health System, 5301 McAuley Drive, Ypsilanti, MI, USA
| | - Robert A Swor
- Department of Emergency Medicine, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine Jacksonville, 1515 SW Archer Road, Gainesville, FL, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, USA
| | - Jeffrey S Jones
- Department of Emergency Medicine, Spectrum Health - Butterworth Campus, 100 Michigan St. NE, 49503, Grand Rapids, MI, USA
| | - David C Lee
- Department of Emergency Medicine, North Shore University Hospital, 300 Community Dr, Manhasset, NY, USA
| | - Mark A Weaver
- Department of Medicine, University of North Carolina, 170 Manning Dr, Chapel Hill, NC, USA
| | - Francis J Keefe
- Department of Psychiatry, Duke University, Durham, 17 Chapel Drive, Durham, NC, USA
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina, 170 Manning Dr, Chapel Hill, NC, USA
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Platts-Mills TF, Flannigan SA, Bortsov AV, Smith S, Domeier RM, Swor RA, Hendry PL, Peak DA, Rathlev NK, Jones JS, Lee DC, Keefe FJ, Sloane PD, McLean SA. Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study. Ann Emerg Med 2015; 67:166-176.e1. [PMID: 26092559 DOI: 10.1016/j.annemergmed.2015.05.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/28/2015] [Accepted: 05/04/2015] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE Motor vehicle crashes are the second most common form of trauma among older adults. We seek to describe the incidence, risk factors, and consequences of persistent pain among older adults evaluated in the emergency department (ED) after a motor vehicle crash. METHODS We conducted a prospective longitudinal study of patients aged 65 years or older who presented to one of 8 EDs after motor vehicle crash between June 2011 and June 2014 and were discharged home after evaluation. ED evaluation was done through in-person interview; follow-up data were obtained through mail-in survey or telephone call. Pain severity (0 to 10 scale) overall and for 15 parts of the body were assessed at each follow-up point. Principal component analysis was used to assess the dimensionality of the locations of pain data. Participants reporting pain severity greater than or equal to 4 attributed to the motor vehicle crash at 6 months were defined as having persistent pain. RESULTS Of the 161 participants, 72% reported moderate to severe pain at the ED evaluation. At 6 months, 26% of participants reported moderate to severe motor vehicle crash-related pain. ED characteristics associated with persistent pain included acute pain severity; pain located in the head, neck, and jaw or lower back and legs; poor self-rated health; less formal education; pre-motor vehicle crash depressive symptoms; and patient's expected time to physical recovery more than 30 days. Compared with individuals without persistent pain, those with persistent pain were substantially more likely at 6-month follow-up to have also experienced a decline in their capacity for physical function (73% versus 36%; difference=37%; 95% confidence interval [CI] 19% to 52%), a new difficulty with activities of daily living (42% versus 17%; difference=26%; 95% CI 10% to 43%), a 1-point or more reduction in overall self-rated health on a 5-point scale (54% versus 30%; difference=24%; 95% CI 6% to 41%), and a change in their living situation to obtain additional help (23% versus 8%; difference=15%; 95% CI 2% to 31%). CONCLUSION Among older adults discharged home from the ED post-evaluation after a motor vehicle crash, persistent pain is common and frequently associated with functional decline and disability.
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Affiliation(s)
- Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC; Department of Anesthesiology, University of North Carolina, Chapel Hill, NC.
| | - Sean A Flannigan
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Andrey V Bortsov
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Samantha Smith
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Robert M Domeier
- Department of Emergency Medicine, St Joseph Mercy Hospital, Ypsilanti, MI
| | - Robert A Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida Health, Jacksonville, FL
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Niels K Rathlev
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA
| | | | - David C Lee
- Department of Emergency Medicine, North Shore Hospital System, Manhasset, NY
| | - Francis J Keefe
- Department of Psychology and Neuroscience, Duke University, Durham, NC
| | - Philip D Sloane
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC; Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
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Richmond NL, Flannigan SA, Keil LG, Betz ME, Platts-Mills TF. Cessation of driving is rare in older drivers seen in the emergency department after a motor vehicle collision: a prospective cohort study. J Am Geriatr Soc 2015; 63:183-5. [PMID: 25597573 DOI: 10.1111/jgs.13223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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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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Platts-Mills TF, Owens ST, McBride JM. A modern-day purgatory: older adults in the emergency department with nonoperative injuries. J Am Geriatr Soc 2014; 62:525-8. [PMID: 24617946 DOI: 10.1111/jgs.12699] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Older adults frequently present to the emergency department (ED) with injuries that do not require operative treatment but are sufficiently severe to make it unsafe for them to return home. These individuals typically do not meet criteria for hospital admission, but because of limited reimbursement for observation, admitting physicians are often reluctant to accept these individuals for observation. Admission to a skilled nursing or assisted living facility from the ED or rapid access to additional in-home care is also often difficult or impossible. As a result, older adults with nonoperative injuries often spend a long time in the ED waiting for an appropriate disposition. The challenges of identifying an appropriate disposition for these individuals, the consequences for patients, and some potential solutions to this commonly encountered problem are described.
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Affiliation(s)
- Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
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Offerman SR, Nishijima DK, Holmes JF. In reply. Acad Emerg Med 2013; 20:856. [PMID: 24033629 DOI: 10.1111/acem.12187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Steven R Offerman
- Department of Emergency Medicine, Kaiser Permanente Northern California, Oakland, CA.
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Platts-Mills TF, Keil LG. Delayed telephone consent in emergency medicine research. Acad Emerg Med 2013; 20:855. [PMID: 23879772 DOI: 10.1111/acem.12183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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. Pain distribution and predictors of widespread pain in the immediate aftermath of motor vehicle collision. Eur J Pain 2013; 17:1243-51. [PMID: 23335385 DOI: 10.1002/j.1532-2149.2013.00285.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Musculoskeletal pain is common after motor vehicle collision (MVC). The study objective was to evaluate distribution of pain and predictors of widespread musculoskeletal pain in the early aftermath (within 48 h) of collision. METHODS European American adults aged 18-65 years presenting to the emergency department (ED) after collision who were discharged to home after evaluation were eligible. Evaluation included an assessment of reported pre-collision psychological characteristics, crash characteristics, current pain severity and location, and current psychological symptoms. Adjusted risk ratios were estimated using generalized linear models. RESULTS Among 890 participants included in the study, 589/890 (66%) had pain in three or more regions, and 192/890 (22%) had widespread musculoskeletal pain (pain in seven or more regions). In adjusted analyses, the presence of widespread pain was strongly associated with depressive and somatic symptoms prior to collision, pain catastrophizing, and acute psychological symptoms, and was not associated with most collision characteristics (road speed limit, extent of vehicle damage, collision type, driver vs. passenger, airbag deployment). The reported number of body regions that struck an object during the collision was associated with both reported pre-collision depressive symptoms and with widespread pain. CONCLUSION More than one in five individuals presenting to the ED in the hours after MVC have widespread pain. Widespread pain is strongly associated with patient characteristics known to be modulated by supraspinal mechanisms, suggesting that stress-induced hyperalgesia may influence acute widespread pain after collision.
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Affiliation(s)
- A V Bortsov
- Department of Anesthesiology, University of North Carolina, Chapel Hill, USA
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