Prevalence and incidence of longer term pain in survivors of polytrauma

Abstract

Little is known about the longer term status of pain or the factors associated with pain-related outcome in patients after polytrauma. The current study evaluated the prevalence and severity of pain at least 2 years after injury compared with preinjury status using several pain scores in a Swiss cohort of survivors of blunt polytrauma. Pearson correlation testing was used for the comparison of different measures of pain. Uni and multivariate analyses of patient, trauma, and treatment characteristics, as well as parameters of self-reported, health-related quality of life and functional outcome, were undertaken to determine associations with pain after polytrauma. Depending on the measure used, 46% to 85% of polytrauma survivors indicated the presence of pain at longer term follow-up. Both the prevalence and the severity of pain were increased compared with the preinjury status (P < .001) and varied importantly depending on scoring. The Trauma Outcome Profile was the most sensitive pain measure and showed the greatest correlation with objective, longer term outcomes (R = .5). Pain measured by the SF-36 was found to have the best internal criterion validity among the scores investigated (R = .6-.8). Patients' longer term pain status had greater associations with health-related quality-of-life scores (R = .6-.8) than with capacity to work or income (R = .4-.5). Our study shows a high rate of longer term pain in survivors of polytrauma and important differences in the type and sensitivity of the standard pain measures investigated. Given the potential impact of these findings, international guidelines for the assessment of pain in polytraumatized patients are needed.