Chronic widespread pain after motor vehicle collision typically occurs through immediate development and nonrecovery

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Abstract

Motor vehicle collision (MVC) can trigger chronic widespread pain (CWP) development in vulnerable individuals. Whether such CWP typically develops through the evolution of pain from regional to widespread or through the early development of widespread pain with nonrecovery is currently unknown. We evaluated the trajectory of CWP development (American College of Rheumatology criteria) among 948 European-American individuals who presented to the emergency department (ED) for care in the early aftermath of MVC. Pain extent was assessed in the ED and 6 weeks, 6 months, and 1 year after MVC on 100%, 91%, 89%, and 91% of participants, respectively. Individuals who reported prior CWP at the time of ED evaluation (n = 53) were excluded. Trajectory modeling identified a 2-group solution as optimal, with the Bayes Factor value (138) indicating strong model selection. Linear solution plots supported a nonrecovery model. Although the number of body regions with pain in the non-CWP group steadily declined, the number of body regions with pain in the CWP trajectory group (192/895, 22%) remained relatively constant over time. These data support the hypothesis that individuals who develop CWP after MVC develop widespread pain in the early aftermath of MVC, which does not remit.

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Most cited references 26

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Screening for Depression in Primary Care Clinics: The CES-D and the BDI

Jane Zich, Thomas K. Greenfield, C. Clifford Attkisson (1990)

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Does the number of musculoskeletal pain sites predict work disability? A 14-year prospective study.

Yusman Kamaleri, Bård Natvig, Camilla M Ihlebaek … (2009)

Various risk factors associated with disability pensioning have been reported. This study investigated the relationship between the number of pain sites and risk of receiving a disability pension. We hypothesised that risk of work disability would increase as the number of pain sites increased, even after controlling for potential confounders. In 1990 and 2004, questionnaire on musculoskeletal pain was sent via post to six age groups in Ullensaker, Norway. Data on demographic, health and work-related variables were also collected. After excluding individuals due to reach retirement age in 2004, we followed 1354 (66%) persons who were classified in 1990 as "employed", "unemployed", "homemaker", or "student". Among them, 176 persons had received long-term or permanent work disability pension in 2004. Bivariate analyses showed that the prevalence of disability pensions was strongly associated with the number of pain sites. Controlling for gender and age almost unaltered the relationship. However, a model controlling for all significant confounders showed that general health and sick leave previous year captured almost all the predictive power of the number of pain sites on work disability. Since these variables could be seen as intermediate variables and not confounders, they were excluded in a new model which gave a strong "dose-response" relationship between number of pain sites and disability with a 10-fold increase from 0 to 9-10 pain sites. The predictive validity of the number of pain sites in determining future disability renders this simple measurement useful for future research on musculoskeletal pain and functioning.

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Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain: findings of a population-based prospective cohort study.

J McBeth, C Michael Dickens, Niall G. MacFarlane … (2007)

To test the hypothesis that abnormalities in the hypothalamic-pituitary-adrenal (HPA) stress-response system would act as an effect moderator between HPA function and the onset of chronic widespread pain (CWP). We conducted a population-based prospective cohort study. Current pain and psychosocial status were ascertained in 11,000 subjects. Of the 768 eligible subjects free of CWP but at future risk based on their psychosocial profile, 463 were randomly selected, and 267 (57.7%) consented to assessment of their HPA axis function. Diurnal function was measured by assessing levels of salivary cortisol in the morning (9:00 AM) and evening (10:00 PM). Serum cortisol levels were measured after an overnight low-dose (0.25 mg) dexamethasone suppression test and a potentially stressful clinical examination. All subjects were followed up 15 months later to identify cases of new-onset CWP. A total of 241 subjects (94.9%) completed the followup study, and 28 (11.6%) reported the new onset of CWP. High levels of cortisol post-dexamethasone (odds ratio [OR] 3.53, 95% confidence interval [95% CI] 1.17-10.65), low levels in morning saliva (OR 1.43, 95% CI 0.52-3.94), and high levels in evening saliva (OR 2.32, 95% CI 0.64-8.42) were all associated with CWP. These 3 factors were found to be independent and additive predictors of CWP (OR for all 3 factors 8.5, 95% CI 1.5-47.9) in analyses controlling for age, sex, depression, sleep disturbance, recent traumatic life events, and pain status. One or more of these 3 HPA factors identified 26 (92.9%) cases of new-onset CWP. Among a group of psychologically at-risk subjects, dysfunction of the HPA axis helps to distinguish those who will and will not develop new-onset CWP.