Incidence and predictors of neck and widespread pain after... : PAIN (original) (raw)

Article

Incidence and predictors of neck and widespread pain after motor vehicle collision among US litigants and nonlitigants

McLean, Samuel A.a,b,c,*; Ulirsch, Jacob C.a,b; Slade, Gary D.d; Soward, April C.a,b; Swor, Robert A.e; Peak, David A.f; Jones, Jeffrey S.g; Rathlev, Niels K.h; Lee, David C.i; Domeier, Robert M.j; Hendry, Phyllis L.k; Bortsov, Andrey V.a,b; Bair, Ericd

a_TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC, USA_

b_Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA_

c_Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA_

d_School of Dentistry, University of North Carolina, Chapel Hill, NC, USA_

e_Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA_

f_Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA_

g_Department of Emergency Medicine, Spectrum Health System, Grand Rapids, MI, USA_

h_Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA_

i_Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA_

j_Department of Emergency Medicine, Saint Joseph Mercy Health System, Ypsilanti, MI, USA_

k_Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA_

* Corresponding author. Address: University of North Carolina, Medical School Wing C CB#7010, Chapel Hill, NC 27599-7010, USA. Tel.: +1 919 843 5931; fax: +1 919 966 7193.

E-mail address:[email protected]

Article history:

Received 8 May 2013

Received in revised form 11 September 2013

Accepted 15 October 2013

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Abstract

Summary

Most individuals with pain sequelae 6 weeks after motor vehicle collision are not engaged in litigation. Evidence supports bidirectional effects between litigation and post–motor vehicle collision musculoskeletal pain outcomes.

Debate continues regarding the influence of litigation on pain outcomes after motor vehicle collision (MVC). In this study we enrolled European Americans presenting to the emergency department (ED) in the hours after MVC (n = 948). Six weeks later, participants were interviewed regarding pain symptoms and asked about their participation in MVC-related litigation. The incidence and predictors of neck pain and widespread pain 6 weeks after MVC were compared among those engaged in litigation (litigants) and those not engaged in litigation (nonlitigants). Among the 859 of 948 (91%) participants completing 6-week follow-up, 711 of 849 (83%) were nonlitigants. Compared to nonlitigants, litigants were less educated and had more severe neck pain and overall pain, and a greater extent of pain at the time of ED evaluation. Among individuals not engaged in litigation, persistent pain 6 weeks after MVC was common: 199 of 711 (28%) had moderate or severe neck pain, 92 of 711 (13%) had widespread pain, and 29 of 711 (4%) had fibromyalgia-like symptoms. Incidence of all 3 outcomes was significantly higher among litigants. Initial pain severity in the ED predicted pain outcomes among both litigants and nonlitigants. Markers of socioeconomic disadvantage predicted worse pain outcomes in litigants but not nonlitigants, and individual pain and psychological symptoms were less predictive of pain outcomes among those engaged in litigation. These data demonstrate that persistent pain after MVC is common among those not engaged in litigation, and provide evidence for bidirectional influences between pain outcomes and litigation after MVC.