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March 25, 2008 — Patients who have sustained a traumatic injury continued to have moderately severe pain 1 year after the injury, suggesting that better pain interventions are needed, according to the results of a study reported in the March issue of the Archives of Surgery.
"Recent studies with long-term follow-up of trauma revealed that 5 to 7 years after injury, chronic pain was present in most patients who sustained pelvic fractures and serious lower extremity injuries," write Frederick P. Rivara, MD, MPH, from the University of Washington in Seattle, and colleagues. "Pain was an important contributor to disability in these patients and often interacted with other sequelae of trauma, such as posttraumatic stress disorder and depression, to affect functional recovery."
This study aimed to determine the prevalence of pain in a large cohort of trauma patients 1 year after injury as well as to identify personal, injury-related, and treatment factors predicting the presence of chronic pain in these patients.
At 69 hospitals in 14 US states, 3047 patients (10,371 weighted) aged 18 to 84 years were hospitalized for acute traumatic injuries and survived to 12 months after the injuries. The primary endpoint was pain 12 months after injury, measured with the Chronic Pain Grade Scale.
At 12 months after injury, 62.7% of patients reported injury-related pain, and most of these reported pain in more than 1
body region. On a 10-point scale, the mean severity of pain in the last month was
5.5 ± 4.8. Reported pain varied with age and was more frequent in women and in those with untreated depression preceding the injury.
The presence of pain at 3 months predicted both the presence and degree of severity of pain at 12 months. Patients with a college education and those with no previous functional limitations tended to report lower pain severity.
"Most trauma patients have moderately severe pain from their injuries 1 year later," the study authors write. "Earlier and more intensive interventions to treat pain in trauma patients may be needed."
Limitations of the study include inability to evaluate the adequacy of in-hospital pain control as a factor that might affect long-term prevalence or severity of pain, inability to evaluate the use of pain control service consultants among study patients, and retrospective recall of intensity and persistence of pain.
"The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed," the study authors conclude. "The high prevalence of pain, its severity, and its effect on functioning warrant such interventions. This may consist of interventions during the acute phase of hospitalization to aggressively treat early pain and better manage neuropathic pain."
The National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, and the National Institute on Aging, National Institutes of Health funded this study. Three of the study authors have obtained funding. The other study authors have disclosed no relevant financial relationships.
Arch Surg. 2008;143:282-287.
Previous traumatic injury is ascribed as a cause of pain in 18.7% of patients seeking treatment. In longitudinal studies of trauma patients, chronic pain persists in most patients who sustained pelvic fractures and serious lower extremity traumatic injuries, and 73% of patients report pain 7 years after the injury.
This is a study of a cohort of patients who presented with traumatic injury that examines the prevalence of injury-related pain at 12 months after injury and predictors of chronic pain.