Association of pain after trauma with long-term functional and mental health outcomes

Herrera-Escobar, Juan P.; Apoj, Michel; Weed, Christina; Harlow, Alyssa F.; Rafai, Syeda S. Al; Lilley, Elizabeth J.; Kasotakis, George; Brasel, Karen J.; Kaafarani, Haytham M.A.; Velmahos, George C.; Salim, Ali; Haider, Adil H.

doi:10.1097/ta.0000000000002017

Cited by 38 publications

(39 citation statements)

References 31 publications

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“…Injured patients who experience chronic pain are more likely to screen positive for posttraumatic stress disorder and to experience functional limitations while being less likely to be back at work or school one year post-injury. 10,19 The sheer prevalence of chronic pain in both groups in the current study, which is consistent with prior reports in the general trauma population, 20e22 is rather remarkable with 36% of the overall cohort reporting chronic pain requiring medication 6e12 months postinjury. Even with changes in opioid prescribing habits over the last decade, the prevalence of chronic pain and pain requiring medication remains extremely high.…”

Section: Discussionsupporting

confidence: 91%

Reduced chronic pain: Another benefit of recovery at an inpatient rehabilitation facility over a skilled nursing facility?

Herrera-Escobar

Blake

Toppo

et al. 2021

The American Journal of Surgery

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Background: We sought to compare outcomes 6e12 months post-injury between patients discharged to an inpatient rehabilitation facility (IRF) and a skilled nursing facility (SNF). Methods: Trauma patients admitted to 3 Level-I trauma centers were interviewed to evaluate the presence of daily pain requiring medication, functional outcomes, and physical and mental healthrelated quality-of-life at 6e12 months post-injury. Inverse-probability-of-treatment-weighting (IPTW) eadjusted analyses were performed to compare outcomes between patients who were discharged to IRF vs SNF. Results: A total of 519 patients were included: 389 discharged to IRFs and 130 to SNFs. In adjusted analyses, IRF was associated with a significant reduction in the likelihood of chronic pain after injury (28.3% vs. 44.7%; OR:0.49; 95% CI, 0.26e0.91; P ¼ .02). However, there were no significant differences in functional outcome or SF-12 composite scores between groups. Conclusion: Our findings suggest that injured patients discharged to an IRF as compared to a SNF had less chronic pain and analgesic use.

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Section: Discussionsupporting

confidence: 91%

Reduced chronic pain: Another benefit of recovery at an inpatient rehabilitation facility over a skilled nursing facility?

Herrera-Escobar

Blake

Toppo

et al. 2021

The American Journal of Surgery

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“…These important pre-injury characteristics should be included in future studies to further investigate important risk factors for mental health problems after physical injury. Additionally, other outcome variables not included in this study, such as pain levels, are also found to be associated with mental health and functional outcome in other studies (Herrera-Escobar, Kaafarani, Velmahos, Salim, & Haider, 2018 ).…”

Section: Methodsmentioning

confidence: 66%

Anxiety, depression and post-traumatic stress symptoms among injury patients and the association with outcome after injury

Vlegel

Polinder

Toet

et al. 2022

European Journal of Psychotraumatology

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Background Injury patients are at risk for mental health problems, which could result in slower recovery and affect health-related quality of life (HRQoL), health care utilization, and return to work (RTW). Objective In this study, we determined the prevalence of symptoms indicative of probable depression, anxiety, and post-traumatic stress disorder (PTSD) and their association with HRQoL, health care utilization, and RTW in adult injury patients. Method Data on unintentional injuries in adult patients were retrieved from the Dutch Injury Surveillance System (DISS) and a six-month follow-up questionnaire that included the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale-Revised (IES-R) to assess depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, and items on HRQoL (measured with the EQ-5D-5 L and EQ visual analogue scale), health care utilization and RTW. Logistic regression analyses assessed the association between depression, anxiety, and PTSD and HRQoL, health care utilization, and RTW. Results At six months post-injury, 22% ( n = 665/3060) of included patients had scores indicative of probable anxiety disorder (14%), depression (16%), and/or PTSD (6%). These patients had reduced EQ-5D utility scores [β: −0.26 (95% CI: −0.28, −0.23)] and were less likely to RTW [OR: 2.12 (95% CI: 1.34, 3.37)] compared to their counterparts. Both mental and physical health care utilization were significantly higher in patients with symptoms indicative of depression, anxiety, and/or PTSD. Conclusions In injury patients, there is a high occurrence of depression, anxiety, and PTSD symptoms, which is associated with lower HRQoL, higher health care utilization, and lower RTW rates. These results underline the importance of screening and treatment of these symptoms in this population to enhance good recovery of injury patients.

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“…Failure to provide adequate relief from pain can result in prolonged recovery, post-traumatic stress, and delayed return to functionality. [18][19][20][21][22] At the same time, exposure to opioids has been associated with future opioid misuse. 4,23 This poses a great challenge for providers in managing both short-and long-term welfare of patients.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] Many of these children experience moderate to severe pain after trauma, and opioids are one way that pain is treated. [11][12][13][14][15][16][17] Inadequately managed pain can lead to significant long-term consequences, such as post-traumatic stress and substance abuse 7,[18][19][20][21][22] ; however, early exposure to opioids has also been linked to similar outcomes. 4,23,24 Opioids are often first-line treatment for moderate and acute pain after trauma, yet many trauma centers lack clear guidelines for when opioids are indicated in the pediatric trauma population and for the maximum cumulative amount of opioid to administer to pediatric patients.…”

mentioning

confidence: 99%

Who Hurts More? A Multicenter Prospective Study of In-Hospital Opioid Use in Pediatric Trauma Patients in the Midwest

Peláez

Davis

Spilman

et al. 2019

Journal of the American College of Surgeons

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BACKGROUND: Despite increased national attention on misuse of prescription and nonprescription opioids for adolescents and children, little is known about opioid use in a pediatric population during hospitalization for injury. The purpose of this investigation is to describe opioid administration and magnitude of opioid exposure in the first 48 hours of hospitalization in a pediatric trauma population. STUDY DESIGN: This is a secondary analysis of data collected for a randomized, prospective intervention study at 4 Midwestern children's trauma centers. Participants included children ages 10 to 17 years old, admitted to the hospital for unintentional injury. Descriptive statistics and multivariable modeling were used to characterize demographic factors and measure prevalence and magnitude of opioid use within the first 48 hours of hospitalization. RESULTS: Among 299 participants, 82% received at least 1 opioid administration. Children had increased odds of receiving an opioid (odds ratio [OR] 4.25; 95% CI 2.16 to 8.35) for every log increase of Injury Severity Scores (ISS), yet the majority of children with minor injury (61%) also received an opioid. Children with fractures and older children had higher odds of receiving an opioid. Amount of opioid, expressed as morphine milligrams equivalent (MME), significantly increased with child age, ISS, and fracture. CONCLUSIONS: Most pediatric trauma patients received an opioid in the first 48 hours of hospitalization, although prevalence and exposure varied by age, injury, and acuity. Aggressive pain management can be appropriate for injured pediatric patients; however, study results indicate areas for improvement, specifically for children with minor injuries and those receiving excessive opioid amounts.

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Association of pain after trauma with long-term functional and mental health outcomes

Abstract: Therapeutic/Care management, level III.

Cited by 38 publications

References 31 publications

Reduced chronic pain: Another benefit of recovery at an inpatient rehabilitation facility over a skilled nursing facility?

Reduced chronic pain: Another benefit of recovery at an inpatient rehabilitation facility over a skilled nursing facility?

Anxiety, depression and post-traumatic stress symptoms among injury patients and the association with outcome after injury

Who Hurts More? A Multicenter Prospective Study of In-Hospital Opioid Use in Pediatric Trauma Patients in the Midwest

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