Pain distribution and predictors of widespread pain in the immediate aftermath of motor vehicle collision

Authors


  • Funding sources

    Funding for this study was provided by the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (R01 AR056328: Samuel A. McLean). Dr. Platts-Mills is supported by Award Number KL2 RR025746 from the National Center for Research Resources.

  • Conflicts of interest

    Dr. Fillingim is an officer and stockholder in Algynomics, Inc.

Correspondence

Samuel A. McLean

E-mail: smclean@aims.unc.edu

Abstract

Background

Musculoskeletal pain is common after motor vehicle collision (MVC). The study objective was to evaluate distribution of pain and predictors of widespread musculoskeletal pain in the early aftermath (within 48 h) of collision.

Methods

European American adults aged 18–65 years presenting to the emergency department (ED) after collision who were discharged to home after evaluation were eligible. Evaluation included an assessment of reported pre-collision psychological characteristics, crash characteristics, current pain severity and location, and current psychological symptoms. Adjusted risk ratios were estimated using generalized linear models.

Results

Among 890 participants included in the study, 589/890 (66%) had pain in three or more regions, and 192/890 (22%) had widespread musculoskeletal pain (pain in seven or more regions). In adjusted analyses, the presence of widespread pain was strongly associated with depressive and somatic symptoms prior to collision, pain catastrophizing, and acute psychological symptoms, and was not associated with most collision characteristics (road speed limit, extent of vehicle damage, collision type, driver vs. passenger, airbag deployment). The reported number of body regions that struck an object during the collision was associated with both reported pre-collision depressive symptoms and with widespread pain.

Conclusion

More than one in five individuals presenting to the ED in the hours after MVC have widespread pain. Widespread pain is strongly associated with patient characteristics known to be modulated by supraspinal mechanisms, suggesting that stress-induced hyperalgesia may influence acute widespread pain after collision.

Ancillary