2014 American Pain Society Meeting, April 30-May 4, Tampa, Florida
Chronic pain repercussions resulting from car accident injuries was a discussion topic presented at the 2014 American Pain Society Meeting. Reportedly, the number of motor vehicle collisions (MVC) has steadily decreased in the first decade of this millennium, along with fewer recorded injuries. Persistent pain and disability often accompany whiplash and other musculoskeletal injuries from MVCs, most commonly from rear-end collisions. In a study by Holm et al, published in 2007 in the Journal of Rheumatology, it was found that poor expectations of recovery following MVCs is a powerful predictor of adverse outcomes. The article also pointed out that determinants of negative recovery expectations has not been thoroughly studied.
To address this issue, a multi-center team of researchers led by Samuel McLean, MD of the Department of Anesthesiology at the University of North Carolina, Chapel Hill, recruited 948 MVC victims who presented to 1 to 8 emergency departments within 24 hours of their auto collision. Participants were asked to complete a survey that included questions about their pre-accident physical and mental health, initial post-MVC symptoms, the severity of the crash, whether their life was in danger, and sense of fault of causing the collision. Additionally, study participants were asked to predict how long it would take them to recover both emotionally and physically from the trauma.
To determine recovery outcomes, follow-up assessments were set up at 6 weeks, and at 6 and 12 months. Collected data from post-collision assessments showed that expected time for emotional recovery, expected time to physical recovery, and certainty of recovery were only weakly associated. Based on this information, study investigators surmised that recovery expectations are not global but specific to outcome type.
Areas most predictive of poor pain outcomes included physical recovery expectations in the hours after the MVC, whereas emotional recovery was most predictive of post-traumatic stress disorder outcomes. Data collection revealed that acute psychological distress (intense peri-traumatic distress--greater sense of life threat) was most strongly associated with poorer expected recovery, followed by the number of somatic symptoms in the emergency department (dizziness, nausea, ringing in ears), and traits of anxiety. In contrast, those patients that had better self-reported physical health before the accident and traits of optimism had shorter estimated time to recover emotionally. Other predictors of poorer outcomes, included acute pain severity, older age, feeling the other driver was at fault, and incidence of pre-MVC pain and depressive symptoms.
The authors found that acute pain and psychological symptoms are the dominate predictors of physical and emotional recovery. Study outcomes could lead to better psychological assessment and preventive interventions, including counseling following MVC that could reduce transition of acute pain into long-term disability. Further studies were recommended to evaluate these findings.