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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 African-Americans 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: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/02/2020] [Accepted: 08/12/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION African-Americans 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 African-Americans 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 African-Americans 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
| | - Wanting Zhai
- Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island
| | - Roland C. Merchant
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Melissa A. Clark
- Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island
| | - Michael C. Kurz
- University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama
| | - Phyllis Hendry
- University of Florida College of Medicine – Jacksonville, Department of Emergency Medicine, Jacksonville, Florida
| | - Robert A. Swor
- Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan
| | - David Peak
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Claire Pearson
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Robert Domeier
- St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan
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Trevino CM, Cooros JC, Chesney SA, deRoon-Cassini T, Carver TW, Milia DJ. A Call to Follow-Up: Results Regarding Trauma Clinic Follow-Up Patterns. J Trauma Nurs 2020; 26:290-296. [PMID: 31714489 DOI: 10.1097/jtn.0000000000000467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to assess the current practice pattern regarding posthospitalization follow-up of trauma patients among the members of the Eastern Association for the Surgery of Trauma (EAST). An anonymous online multiple-choice survey of EAST members in 2016 was conducted. Ten questions relating to the follow-up care of injured patients were presented to the Active, Senior, and Associate members of EAST. Data were screened for quantitative concerns prior to analysis. Of the 1,610 members surveyed, 289 responded (18%). Approximately 52% of respondents stated that their institution has a dedicated trauma follow-up clinic where most injured patients are seen after discharge. Less than 20% reported that nontrauma multidisciplinary providers are present in clinics. Most (89.5%) reported that follow-up is a single visit, unless a patient has long-standing issues. Only 3 respondents stated that patients are regularly seen 3+ months out from injury, and a significant minority (17.7%) acknowledged no set follow-up timeline. Only 3.6% of participants indicated that they have a psychologist embedded in the trauma team, and 11.5% reported that no system is currently in place to manage mental health. Despite more than 20 years of literature highlighting the long-term physical and mental health sequelae after trauma, these survey results demonstrate that there is a lack of standardized and multidisciplinary follow-up. Given the improvement in outcomes with the identification and treatment of these sequelae, greater attention should be paid to functional recovery, social and psychological well-being, and chronic pain.
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Affiliation(s)
- Colleen M Trevino
- Medical College of Wisconsin, Milwaukee (Drs Trevino, deRoon-Cassini, Carver, and Milia); Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Dr Cooros); and Marquette University, Milwaukee, Wisconsin (Ms Chesney)
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Yavne Y, Amital D, Watad A, Tiosano S, Amital H. A systematic review of precipitating physical and psychological traumatic events in the development of fibromyalgia. Semin Arthritis Rheum 2018; 48:121-133. [DOI: 10.1016/j.semarthrit.2017.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/11/2017] [Accepted: 12/09/2017] [Indexed: 01/09/2023]
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Chronic widespread bodily pain is increased among individuals with history of fracture: findings from UK Biobank. Arch Osteoporos 2016; 11:1. [PMID: 26678491 PMCID: PMC4683164 DOI: 10.1007/s11657-015-0252-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/01/2015] [Indexed: 02/03/2023]
Abstract
SUMMARY In this cross-sectional analysis of the UK Biobank cohort, a history of fracture was associated with increased risk of current widespread chronic pain. PURPOSE/INTRODUCTION We aimed to test the hypothesis that a history of fracture is associated with reporting chronic widespread bodily pain (CWBP), using baseline data from the UK Biobank cohort, comprising 502,656 people aged 40-69 years. METHODS The case definition of current chronic widespread bodily pain was based on a response of 'yes' to the question 'do you have pain all over the body?' and 'yes' to 'and have you experienced pain all over the body for more than 3 months?' Multivariable Poisson regression with robust standard errors was used to test the relationship between fracture (occurring within 5 years prior to the baseline interview, and recorded by self-report) at the spine, hip, upper limb or lower limb and CWBP, adjusting for confounders. RESULTS Of 501,733 participants (mean age 56.5 years), 7130 individuals reported CWBP and 23,177 had a history of fracture affecting the upper limb, lower limb, spine and/or hip. Individuals with prior fracture were significantly more likely to report CWBP than those without. After adjustment for potential risk factors (age, gender, demographic, lifestyle and socioeconomic, and psychological), risk ratios were attenuated but remained statistically significant with a more than doubling of risk for CWBP with spine fractures in men (risk ratio (RR) 2.67, 95% confidence interval (CI) 1.66-4.31; p < 0.001) and women (RR 2.13, 95% CI 1.35-3.37, p = 0.001) and with hip fractures in women (RR 2.19, 95% CI 1.33-3.59; p = 0.002). CONCLUSIONS In this cross-sectional analysis, previous fracture is associated with an increased likelihood of chronic widespread bodily pain, particularly with hip fractures in women, and spine fractures in both sexes. If replicated, these findings may help inform the identification of those most at risk of chronic widespread pain post-fracture, allowing preventative measures to be targeted.
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Gopinath B, Jagnoor J, Nicholas M, Blyth F, Harris IA, Casey P, Cameron ID. Presence and predictors of persistent pain among persons who sustained an injury in a road traffic crash. Eur J Pain 2014; 19:1111-8. [PMID: 25487140 DOI: 10.1002/ejp.634] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a paucity of prospective studies with long follow-up that have examined a wide range of correlates associated with persistent pain outcomes in persons who sustained a mild or moderate injury in a road traffic crash. This study aimed to establish the independent predictors of pain severity over 24 months. METHODS A total of 364, 284 and 252 persons with mild/moderate musculoskeletal injuries sustained in a vehicle-related crash participated in telephone interviews in the subacute phase, and at 12 and 24 months, respectively. The numeric rating scale (NRS) assessed pain severity. Pain-Related Self-Statements Scale-Catastrophizing (PRSS-Catastrophizing) and the Short Form Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) were also administered. RESULTS After multivariable adjustment, each 1 SD increase in Short Form-12 Physical Component Score (SF-12 PCS) in the subacute phase was associated with 0.73 (p = 0.002) and 1.11 (p < 0.0001) decrease in NRS scores after 12 and 24 months, respectively. Each unit increase in the PRSS-Catastrophizing score in the subacute phase was associated with 0.54 (p = 0.001) and 0.43 (p = 0.03) increase in NRS scores 12 and 24 months later, respectively. Subacute phase OMPSQ scores were positively associated with NRS scores at 12- and 24-month follow-ups (p < 0.0001). CONCLUSIONS Self-perceived physical well-being, pain-related work disability and pain catastrophizing could play a role in determining long-term pain-related outcomes following traffic-related injuries.
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Affiliation(s)
- B Gopinath
- John Walsh Centre for Rehabilitation Studies, Sydney Medical School, University of Sydney, Australia.,Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Australia
| | - J Jagnoor
- John Walsh Centre for Rehabilitation Studies, Sydney Medical School, University of Sydney, Australia
| | - M Nicholas
- Pain Management Research Institute, Sydney Medical School, University of Sydney, Australia
| | - F Blyth
- Pain Management Research Institute, Sydney Medical School, University of Sydney, Australia.,School of Public Health, University of Sydney, Australia
| | - I A Harris
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Australia
| | - P Casey
- John Walsh Centre for Rehabilitation Studies, Sydney Medical School, University of Sydney, Australia
| | - I D Cameron
- John Walsh Centre for Rehabilitation Studies, Sydney Medical School, University of Sydney, Australia
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Wolfe F, Häuser W, Walitt BT, Katz RS, Rasker JJ, Russell AS. Fibromyalgia and Physical Trauma: The Concepts We Invent. J Rheumatol 2014; 41:1737-45. [DOI: 10.3899/jrheum.140268] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite weak to nonexistent evidence regarding the causal association of trauma and fibromyalgia (FM), literature and court testimony continue to point out the association as if it were a strong and true association. The only data that appear unequivocally to support the notion that trauma causes FM are case reports, cases series, and studies that rely on patients’ recall and attribution — very low-quality data that do not constitute scientific evidence. Five research studies have contributed evidence to the FM-trauma association. There is no scientific support for the idea that trauma overall causes FM, and evidence in regard to an effect of motor vehicle accidents on FM is weak or null. In some instances effect may be seen to precede cause. Alternative causal models that propose that trauma causes “stress” that leads to FM are unfalsifiable and unmeasurable.
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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: 75] [Impact Index Per Article: 7.5] [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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Trevino CM, deRoon-Cassini T, Brasel K. Does opiate use in traumatically injured individuals worsen pain and psychological outcomes? THE JOURNAL OF PAIN 2013; 14:424-30. [PMID: 23548492 DOI: 10.1016/j.jpain.2012.12.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/08/2012] [Accepted: 12/26/2012] [Indexed: 12/17/2022]
Abstract
UNLABELLED Opiate use for chronic pain is becoming increasingly controversial. There has been a shift away from supporting the use of opiates for treatment of chronic pain. In addition to lack of effectiveness, concerns for adverse clinical outcomes, addiction, and death have provided the impetus for this change. The purpose of this study was to investigate the percent of trauma patients still using opiates, their pain levels, and psychological outcomes 4 months posttrauma. This was a study to evaluate chronic pain at 4 months posttrauma in 101 participants from a single level 1 trauma center. Eighty of the 101 participants developed chronic pain 4 months after their initial traumatic injury (79%). Of those who developed chronic pain, 27 (26%) were still using opiates. Those using narcotics at 4 months posttrauma had significantly more pain, life interference, depression, and anxiety. Posttraumatic stress disorder (PTSD) was not significantly influenced by narcotic use in this analysis. However, the mean associated with those using narcotics was higher and diagnostic for PTSD. Those taking opiates did not have significantly better relief from their pain using treatments or medications than those not using opiates (F = 8, P = .08). These findings bring into question the appropriate use of opiates for chronic pain and the possible exacerbating effects on pain and psychopathology in traumatically injured patients. PERSPECTIVE This article identifies data that provide evidence that narcotic pain medication needs to be used carefully in traumatically injured patients with chronic pain, especially in those individuals with comorbid psychological pathology.
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Affiliation(s)
- Colleen M Trevino
- Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226, USA.
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Trauma and work-related pain syndromes: risk factors, clinical picture, insurance and law interventions. Best Pract Res Clin Rheumatol 2012; 25:199-207. [PMID: 22094196 DOI: 10.1016/j.berh.2011.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2010] [Indexed: 11/20/2022]
Abstract
In the past decade, major progress has been made in our understanding of fibromyalgia syndrome (FMS). Various triggers have been implicated as contributing to symptom development in FMS when genetically susceptible individuals are challenged. A substantial amount of data points towards the association between trauma and chronic widespread pain/fibromyalgia syndrome (CWP/FMS). There is abundant data suggesting that the pathogenesis of CWP/FMS might be related to cervical spine injury. Furthermore, several persistent local pain conditions may progress to CWP/FMS. These conditions may share a common pathogenic mechanism namely, central sensitisation. Physical trauma and emotional trauma co-exist in many traumatic events and may interact in the pathogenesis of CWP/FMS.
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Jones GT, Nicholl BI, McBeth J, Davies KA, Morriss RK, Dickens C, Macfarlane GJ. Role of road traffic accidents and other traumatic events in the onset of chronic widespread pain: Results from a population-based prospective study. Arthritis Care Res (Hoboken) 2011; 63:696-701. [DOI: 10.1002/acr.20417] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Can fibromyalgia be associated with whiplash injury? A 3-year follow-up study. Rheumatol Int 2010; 31:1209-13. [PMID: 20358206 DOI: 10.1007/s00296-010-1412-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 02/27/2010] [Indexed: 10/19/2022]
Abstract
The objective of this study is to assess the long-term outcome and natural history of a cohort of patients with whiplash injury regarding the development of fibromyalgia. Of the 153 patients who were admitted to the emergency room after whiplash injury in 2004, 126 were reassessed 3 years later. Also, 33 of 53 patients from the original control group of hospitalized patients with fractures were reevaluated. Patients were interviewed by phone and by written forms using a detailed questionnaire. Patients who complained of musculoskeletal symptoms were invited and examined. The study group included 68 men and 58 women, with a mean age of 50.1 ± 9.7. The control group included 19 men and 14 women with a mean age of 44.2 ± 10.3. Follow-up period did not differ significantly between the groups 38.3 ± 2.3 vs. 36.4 ± 4.2 months. At the end of the follow-up period, three patients in the study group compared with one patient in the control group were diagnosed as having fibromyalgia; all of them were women. The rate of new onset widespread pain increased with time in both groups. Symptoms of dizziness, headaches, fatigue and sleep disturbances improved, as well as the quality of life (QOL) and the Fibromyalgia Impact Questionnaire (FIQ) scores. Insurance claims continued to be more prevalent in the control group. The results of this extended follow-up study confirm previous short-term results showing that whiplash injury and road accident trauma are not associated with an increased risk of fibromyalgia.
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Pang D, Jones GT, Power C, Macfarlane GJ. Influence of childhood behaviour on the reporting of chronic widespread pain in adulthood: results from the 1958 British Birth Cohort Study. Rheumatology (Oxford) 2010; 49:1882-8. [DOI: 10.1093/rheumatology/keq052] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jones GT, Power C, Macfarlane GJ. Adverse events in childhood and chronic widespread pain in adult life: Results from the 1958 British Birth Cohort Study. Pain 2009; 143:92-6. [DOI: 10.1016/j.pain.2009.02.003] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/28/2008] [Accepted: 02/04/2009] [Indexed: 11/29/2022]
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