Persistent and Widespread Pain Among African-Americans Six Weeks after MVC: Emergency Department-based Cohort Study.

,Francesca Beaudoin,Samuel Mclean,Christine Ortiz,Roland Merchant,Phyllis Hendry,David Peak,Robert Swor,Robert Domeier,Melissa Clark,Michael Kurz,Wanting Zhai,Claire Pearson

doi:10.5811/westjem.2020.8.47450

Abstract

IntroductionAfrican Americans in the United States experience greater persistent pain than non-Hispanic Whites across a range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factors or incidence of persistent pain among African Americans experiencing common traumatic stress exposures such as after a motor vehicle collision (MVC). We evaluated the incidence and predictors of moderate to severe axial musculoskeletal pain (MSAP) and widespread pain six weeks after a MVC in a large cohort of Black adults presenting to the emergency department (ED) for care.MethodsThis prospective, multi-center, cohort study enrolled Black adults who presented to one of 13 EDs across the US within 24 hours of a MVC and were discharged home after their evaluation. Data were collected at the ED visit via patient interview and self-report surveys at six weeks after the ED visit via internet-based, self-report survey, or telephone interview. We assessed MSAP pain at ED visit and persistence at six weeks. Multivariable models examined factors associated with MSAP persistence at six weeks post-MVC.ResultsAmong 787 participants, less than 1% reported no pain in the ED after their MVC, while 79.8 (95% confidence interval [CI], 77.1 – 82.2) reported MSAP and 28.3 (95% CI, 25.5 – 31.3) had widespread pain. At six weeks, 67% (95% CI, 64, 70%) had MSAP and 31% (95% CI, 28, 34%) had widespread pain. ED characteristics predicting MSAP at six weeks post-MVC (area under the curve = 0.74; 95% CI, 0.72, 0.74) were older age, peritraumatic dissociation, moderate to severe pain in the ED, feeling uncertain about recovery, and symptoms of depression.ConclusionThese data indicate that African Americans presenting to the ED for evaluation after MVCs are at high risk for persistent and widespread musculoskeletal pain. Preventive interventions are needed to improve outcomes for this high-risk group.

Highlights

Blacks in the United States experience greater persistent pain than non-Hispanic Whites across a range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factors or incidence of persistent pain among Blacks experiencing common traumatic stress exposures such as after a motor vehicle collision (MVC)
We evaluated the incidence and predictors of moderate to severe axial musculoskeletal pain (MSAP) and widespread pain six weeks after a MVC in a large cohort of Black adults presenting to the emergency department (ED) for care
Among 787 participants, less than 1% reported no pain in the ED after their MVC, while 79.8 (95% confidence interval [confidence intervals (CI)], 77.1 – 82.2) reported MSAP and 28.3 had widespread pain

Summary

Introduction

Blacks in the United States experience greater persistent pain than non-Hispanic Whites across a range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factors or incidence of persistent pain among Blacks experiencing common traumatic stress exposures such as after a motor vehicle collision (MVC). Blacks are a historically understudied population that has consistently been shown to experience an increased burden of pain in other settings.[9,10,11,12,13,14,15,16,17,18] Reasons for this increased burden of pain remain poorly understood While some of this increased vulnerability to pain may be due to greater socioeconomic disadvantages,[19] data from other clinical conditions suggests that worse health outcomes such as chronic pain among Blacks are not likely to be accounted for by socioeconomic differences alone.[20]

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