Abstract
BackgroundPersistent musculoskeletal pain and psychological sequelae following minor motor vehicle collision (MVC) are common problems with a large economic cost. Prospective studies of pain following MVC have demonstrated that demographic characteristics, including female gender and low education level, and psychological characteristics, including high pre-collision anxiety, are independent predictors of persistent pain. These results have contributed to the psychological and social components of a biopsychosocial model of post-MVC pain pathogenesis, but the biological contributors to the model remain poorly defined. Recent experimental studies indicate that genetic variations in adrenergic system function influence the vulnerability to post-traumatic pain, but no studies have examined the contribution of genetic factors to existing predictive models of vulnerability to persistent pain.Methods/DesignThe Project CRASH study is a federally supported, multicenter, prospective study designed to determine whether variations in genes affecting synaptic catecholamine levels and alpha and beta adrenergic receptor function augment social and psychological factors in a predictive model of persistent musculoskeletal pain and posttraumatic stress disorder (PTSD) following minor MVC. The Project CRASH study will assess pain, pain interference and PTSD symptoms at 6 weeks, 6 months, and 1 year in approximately 1,000 patients enrolled from 8 Emergency Departments in four states with no-fault accident laws.DiscussionThe results from this study will provide insights into the pathophysiology of persistent pain and PTSD following MVC and may serve to improve the ability of clinicians and researchers to identify individuals at high risk for adverse outcomes following minor MVC.
Highlights
Persistent musculoskeletal pain and psychological sequelae following minor motor vehicle collision (MVC) are common problems with a large economic cost
This report describes the methods of Project CRASH, an example of a type of emergency department (ED)-based inception cohort study which we anticipate will become increasingly common in the future
If a particular physiologic system is involved in the pathogenesis of a disorder, genetic variations influencing the function of this system would be expected to be associated with vulnerability to develop the disorder and to improve prediction of which individuals will develop this disorder
Summary
ED-based inception cohort studies such as Project CRASH, which combine genotypic and phenotypic data collection, are likely to become increasingly common for several reasons. Further knowledge of the physiologic systems which mediate disease outcomes has the potential to enhance our ability to identify high-risk individuals and/or to suggest novel preventive interventions. These studies require relatively large number of patients, which ED-based networks can provide. Haplotype frequencies for COMT genes are different between Caucasians, African Americans, and Asians [23] This necessitates stratified analyses, and the size of each strata must be large, often limiting a study to a single strata within the context of the budget of a particular grant mechanism.
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