Incidence and predictors of neck and widespread pain after motor vehicle collision among US litigants and nonlitigants

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 six weeks after MVC were compared among those engaged in litigation ("litigants") and those not engaged in litigation ("non-litigants"). Among the 859/948 (91%) participants completing six week follow-up, 711/849 (83%) were non-litigants. Compared to non-litigants, litigants were less educated and had more severe neck pain, overall pain, and a greater extent of pain at the time of ED evaluation. Among individuals not engaged in litigation, persistent pain six weeks after MVC was common: 199/711 (28%) had moderate or severe neck pain, 92/711 (13%) had widespread pain, and 29/711 (4%) had fibromyalgia-like symptoms. Incidence of all three outcomes was significantly higher among litigants. Initial pain severity in the ED predicted pain outcomes among both litigants and non-litigants. Markers of socioeconomic disadvantage predicted worse pain outcomes in litigants but not non-litigants, 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.

Long-term follow-up of whiplash injuries reported to insurance companies: a cohort study on patient-reported outcomes and impact of financial compensation

“…This prospective study highlights previous findings that nonrecovery rates remain relatively high after whiplash trauma [18] in an insurance company setting even after 2-4 years. To the best of our knowledge, this is the first prospective study with a long-term follow-up of participants recruited from insurance companies.…”

Thoracic dysfunction in whiplash associated disorders: a systematic review

“…Despite the very low quality of included studies, there is evidence of thoracic spine pain in a sub-acute WAD population (n = 11,576) [11,14,17,34,39,43,52,60], with prevalence ranging between 21%-66%,. Findings were inconsistent in chronic WAD, with prevalence ranging 0-94% [17,50].…”

“…From this review we identified evidence of the following dysfunction,: thoracic spine pain in acute/sub-acute/chronic WAD ranging from minor injuries to more severe (WADIII) presentations [11,14,17,32,33,43,50,52,58,62]; chest pain in acute/sub-acute/chronic WAD [11,17,52,53]; postural changes [44,61] and reduced chest/thoracic mobility in CWAD [61]; thoracic outlet syndrome in CWAD [31,35,36,47,51]; involvement of the brachial plexus at all stages and across all levels of WAD severity [12,46,55,57,59]; muscle dysfunction in the form of the following: 1) heightened activity of the sternocleidomastoid during neck flexion [12,56], 2) delayed onset of serratus anterior during arm elevation at the chronic stage in mild WAD [45] and 3) a high prevalence of myofascial pain and trigger points in the scalene muscles [40,41], sternocleidomastoid [37,40,41] and mid/lower fibres of trapezius [16] within the subacute and chronic stages and across different levels of severity.…”

“…Chest pain. Prevalence of chest pain in acute/sub-acute was reported to range 0.0-19% [11,14,17,52], although when considered as part of a widespread pain presentation ranged 9-19% [11,14]. In one study where they only considered individuals with numerical rating scale (NRS 0-10) 4+ chest pain prevalence was lower at 8% [52].…”

Methodology of AA CRASH: a prospective observational study evaluating the incidence and pathogenesis of adverse post-traumatic sequelae in African-Americans experiencing motor vehicle collision

“…3 Although most of these discharged individuals recover, a substantial proportion develops persistent musculoskeletal pain and/or persistent psychological sequelae such as post-traumatic stress disorder (PTSD). [4][5][6] The development of these adverse posttraumatic sequelae after MVC constitutes a common, morbid and costly public health problem in industrialised countries. [7][8][9] The pathogenesis of adverse sequelae after MVC remains poorly understood.…”