Chronic widespread pain after motor vehicle collision typically occurs through immediate development and nonrecovery

Abstract

Motor vehicle collision (MVC) can trigger chronic widespread pain (CWP) development in vulnerable individuals. Whether such CWP typically develops via the evolution of pain from regional to widespread or via the early development of widespread pain with non-recovery 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 two-group solution as optimal, with the Bayes Factor value (138) indicating strong model selection. Linear solution plots supported a non-recovery model. While 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.

Pain and itch outcome trajectories differ among European American and African American survivors of major thermal burn injury

“…Enrollment flow chart shown in Figure 1. Retaining a low percentage of screened patients in a study is common among trauma populations including previously collected cohorts in motor vehicle collision [29], critical illness [43], burn injury [15; 59] and traumatic brain injury [57]. Of note, of our sample who was approached, 21% refused enrollment, which is consistent with other studies in burn injury [22; 24].…”

The Association Between Daily Posttraumatic Stress Symptoms and Pain Over the First 14 Days After Injury: An Experience Sampling Study

“…Acute postinjury pain transitions into chronic pain when it persists beyond 3 months after the injury . The factors that influence this transition may be therapeutic targets that could reduce the substantial individual and societal burden associated with chronic pain …”

“…Specifically, up to 24% of injured trauma patients report a new‐onset psychiatric disorder at 12 months postinjury, and an estimated 10%–40% develop clinically significant symptoms characteristic of posttraumatic stress disorder (PTSD), including intrusive experiences (e.g., nightmares, flashbacks, or triggers), avoidance of trauma‐related stimuli, negative changes in beliefs and feelings, and increased physiological arousal and reactivity . These psychological reactions are associated with chronic posttraumatic pain, even more so than injury severity or characteristics . Additionally, activation of support networks immediately after a traumatic event enhances adjustment to pain, and poor social support predicts adverse psychological outcomes …”

Pain Sensitivity Modifies Risk of Injury-Related Temporomandibular Disorder

“…Prospective cohort studies avoid such problems by establishing a temporal sequence between injury and development of subsequent pain disorder. A consistent finding from the few available prospective cohort studies is that relatively few individuals who experience injury develop a pain disorder (Hu et al 2016;Sharma et al 2019). A plausible explanation is that some individuals have preexisting traits that hamper recovery from injury, increasing the risk that the initial pain from injury will persist.…”