Francesca L Beaudoin1,1,2,3,4,5,6,7,8,4,9, Wanting Zhai3,1,2,3,4,5,6,7,8,4,9, Roland C Merchant4,1,2,3,4,5,6,7,8,4,9, Melissa A Clark5,1,2,3,4,5,6,7,8,4,9, Michael C Kurz6,1,2,3,4,5,6,7,8,4,9, Phyllis Hendry7,1,2,3,4,5,6,7,8,4,9, Robert A Swor8,1,2,3,4,5,6,7,8,4,9, David Peak4,1,2,3,4,5,6,7,8,4,9, Claire Pearson9,1,2,3,4,5,6,7,8,4,9, Robert Domeier2,1,2,3,4,5,6,7,8,4,9, Christine Ortiz10,1,2,3,4,5,6,7,8,4,9, Samuel A McLean11,1,2,3,4,5,6,7,8,4,9. 1. Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island. 2. St. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, Michigan. 3. Warren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode Island. 4. Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts. 5. Warren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode Island. 6. University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama. 7. University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, Florida. 8. Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan. 9. Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan. 10. Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island. 11. University of North Carolina - Chapel Hill, Department of Anesthesiology and Emergency Medicine, Chapel Hill, North Carolina.
Abstract
INTRODUCTION: African-Americans in the United States experience greater persistent pain than non-Hispanic Whites across a range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factors or incidence of persistent pain among African-Americans experiencing common traumatic stress exposures such as after a motor vehicle collision (MVC). We evaluated the incidence and predictors of moderate to severe axial musculoskeletal pain (MSAP) and widespread pain six weeks after a MVC in a large cohort of Black adults presenting to the emergency department (ED) for care. METHODS: This prospective, multi-center, cohort study enrolled Black adults who presented to one of 13 EDs across the US within 24 hours of a MVC and were discharged home after their evaluation. Data were collected at the ED visit via patient interview and self-report surveys at six weeks after the ED visit via internet-based, self-report survey, or telephone interview. We assessed MSAP pain at ED visit and persistence at six weeks. Multivariable models examined factors associated with MSAP persistence at six weeks post-MVC. RESULTS: Among 787 participants, less than 1% reported no pain in the ED after their MVC, while 79.8 (95% confidence interval [CI], 77.1 - 82.2) reported MSAP and 28.3 (95% CI, 25.5 - 31.3) had widespread pain. At six weeks, 67% (95% CI, 64, 70%) had MSAP and 31% (95% CI, 28, 34%) had widespread pain. ED characteristics predicting MSAP at six weeks post-MVC (area under the curve = 0.74; 95% CI, 0.72, 0.74) were older age, peritraumatic dissociation, moderate to severe pain in the ED, feeling uncertain about recovery, and symptoms of depression. CONCLUSION: These data indicate that African-Americans presenting to the ED for evaluation after MVCs are at high risk for persistent and widespread musculoskeletal pain. Preventive interventions are needed to improve outcomes for this high-risk group.
INTRODUCTION: African-Americans in the United States experience greater persistent pain than non-Hispanic Whites across a range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factors or incidence of persistent pain among African-Americans experiencing common traumatic stress exposures such as after a motor vehicle collision (MVC). We evaluated the incidence and predictors of moderate to severe axial musculoskeletal pain (MSAP) and widespread pain six weeks after a MVC in a large cohort of Black adults presenting to the emergency department (ED) for care. METHODS: This prospective, multi-center, cohort study enrolled Black adults who presented to one of 13 EDs across the US within 24 hours of a MVC and were discharged home after their evaluation. Data were collected at the ED visit via patient interview and self-report surveys at six weeks after the ED visit via internet-based, self-report survey, or telephone interview. We assessed MSAP pain at ED visit and persistence at six weeks. Multivariable models examined factors associated with MSAP persistence at six weeks post-MVC. RESULTS: Among 787 participants, less than 1% reported no pain in the ED after their MVC, while 79.8 (95% confidence interval [CI], 77.1 - 82.2) reported MSAP and 28.3 (95% CI, 25.5 - 31.3) had widespread pain. At six weeks, 67% (95% CI, 64, 70%) had MSAP and 31% (95% CI, 28, 34%) had widespread pain. ED characteristics predicting MSAP at six weeks post-MVC (area under the curve = 0.74; 95% CI, 0.72, 0.74) were older age, peritraumatic dissociation, moderate to severe pain in the ED, feeling uncertain about recovery, and symptoms of depression. CONCLUSION: These data indicate that African-Americans presenting to the ED for evaluation after MVCs are at high risk for persistent and widespread musculoskeletal pain. Preventive interventions are needed to improve outcomes for this high-risk group.
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