Pain and quality of life 1 year after admission to the emergency department: factors associated with pain

Abstract

This study describes the prevalence of pain in trauma patients 1year after hospital admission and investigates separately health-related quality of life (QoL) for patients suffering severe pain and for those without pain. Moreover, psychosocial factors are examined for their impact on pain. Patients were contacted 12months after admission in order to complete the following questionnaires: Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Trauma Outcome Profile (TOP), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Impact of Event Scale-Revised (IES-R) and additional questions concerning satisfaction, work and financial status. Relevant pain at follow-up was defined as <80 points on the pain subscale of the TOP. Two hundred and twenty patients were included. The Injury Severity Score (ISS) ranged from 1 to 41. Fifty-three percent (53%) of patients suffered a severe trauma (ISS>15). One year after injury, 55% of patients had relevant pain according to the TOP. Patients with pain were older (41.4 vs. 34.4 years, p=0.003) and had slightly more severe injuries (ISS 17.1 vs. 14.9, p=0.115). There were significant differences between pain and no-pain patients on all domains of QoL (p<0.001) and on the BDI, STAI and IES-R (p<0.001). Pain patients more often experienced a stressful event and job-related and financial difficulties. Multivariate logistic regression analysis revealed post-traumatic stress disorder (PTSD) as the strongest predictor for pain [odds ratio (OR): 4.38, p=0.015], followed by a stressful life event (OR: 4.08, p=0.001). Pain is strongly associated with psychosocial complaints 1year after trauma. For the treatment of pain following a traumatic event, social reintegration and emotional regulation by means of occupational rehabilitation and psychotherapy should receive more attention.