(237) Most widespread pain present 1 year after motor vehicle collision (MVC) begins in the early aftermath of the MVC: results of a multicenter prospective cohort study

Abstract

Over four million adults present to US emergency departments (EDs) each year after motor vehicle collision (MVC); the great majority of these individuals are discharged to home after ED evaluation. A subset of these individuals develops chronic MVC-related widespread pain (CMWP). Typical trajectories by which individuals develop this morbid outcome (e.g. progressive extension of pain vs. early development with non-recovery) are unknown. We evaluated trajectories of pain extent in a large cohort of adult European Americans who presented to the ED within 24 hours of MVC. Study participants were interviewed in the ED at the time of initial presentation and six weeks, six months, and one year following MVC. Evaluation at each time point included an assessment of pain (0-10 NRS) in nineteen body regions. If pain in a body region was reported, the MVC-relatedness of the pain was assessed. Widespread pain (WP) was defined as MVC-related pain in ≥7 body regions. One year after MVC, 75/948 (9%) of enrolled participants had CMWP. Among this group, almost half (45.3%) had WP in the ED. WP at 6 weeks and 6 months were present in 67.6% and 54.9% of these participants, respectively. Trajectory analyses of extent of pain across time (performed via SAS PROC TRAJ) for the entire cohort (n=948) identified 8.7% of participants with pain distributions over time consistent with a trajectory of initial WP in the ED and non-recovery across time. Together these data support the hypothesis that most individuals developing CMWP after MVC develop early WP that does not remit and suggest that individuals developing CMWP after MVC could be identified in the early post-MVC period and targeted for early preventive interventions. Supported by NIAMS R01AR056328. Over four million adults present to US emergency departments (EDs) each year after motor vehicle collision (MVC); the great majority of these individuals are discharged to home after ED evaluation. A subset of these individuals develops chronic MVC-related widespread pain (CMWP). Typical trajectories by which individuals develop this morbid outcome (e.g. progressive extension of pain vs. early development with non-recovery) are unknown. We evaluated trajectories of pain extent in a large cohort of adult European Americans who presented to the ED within 24 hours of MVC. Study participants were interviewed in the ED at the time of initial presentation and six weeks, six months, and one year following MVC. Evaluation at each time point included an assessment of pain (0-10 NRS) in nineteen body regions. If pain in a body region was reported, the MVC-relatedness of the pain was assessed. Widespread pain (WP) was defined as MVC-related pain in ≥7 body regions. One year after MVC, 75/948 (9%) of enrolled participants had CMWP. Among this group, almost half (45.3%) had WP in the ED. WP at 6 weeks and 6 months were present in 67.6% and 54.9% of these participants, respectively. Trajectory analyses of extent of pain across time (performed via SAS PROC TRAJ) for the entire cohort (n=948) identified 8.7% of participants with pain distributions over time consistent with a trajectory of initial WP in the ED and non-recovery across time. Together these data support the hypothesis that most individuals developing CMWP after MVC develop early WP that does not remit and suggest that individuals developing CMWP after MVC could be identified in the early post-MVC period and targeted for early preventive interventions. Supported by NIAMS R01AR056328.