Advertisement

It still hurts! Persistent pain and use of pain medication one year after injury

      Highlights

      • Almost 1 in 2 trauma patients feel daily pain, one year after injury.
      • Approximately 1 in 4 trauma patients utilize pain medication at one year.
      • ISS was not correlated with chronic pain or long-term use of pain medication.
      • The power of predictors of pain and pain medication use was limited.

      Abstract

      Background

      Given the scarce literature data on chronic post-traumatic pain, we aim to identify early predictors of long-term pain and pain medication use after major trauma.

      Methods

      Major trauma patients (Injury Severity Score ≥ 9) from three Level I Trauma Centers at 12 months after injury were interviewed for daily pain using the Trauma Quality of Life questionnaire. Multivariate logistic regression models identified patient- and injury-related independent predictors of pain and use of pain medication.

      Results

      Of 1238 patients, 612 patients (49%) felt daily pain and 300 patients (24%) used pain medication 1 year after injury. Of a total of 8 independent predictors for chronic pain and 9 independent predictors for daily pain medication, 4 were common (pre-injury alcohol use, pre-injury drug use, hospital stay ≥ 5 days, and education limited to high school). Combinations of independent predictors yielded weak predictability for both outcomes, ranging from 20% to 72%.

      Conclusions

      One year after injury, approximately half of trauma patients report daily pain and one-fourth use daily pain medication. These outcomes are hard to predict.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mkandawire N.C.
        • Boot D.A.
        • Braithwaite I.J.
        • Patterson M.
        Muscoskeletal recovery 5 years after severe injury: long-term problems are common.
        Injury. 2002; 33: 111-115
        • Rivara F.P.
        • Mackenzie E.J.
        • Jurkovich G.J.
        • Nathens A.B.
        • Wang J.
        • Scharfstein D.O.
        Prevalence of pain in patients 1 Year after major trauma.
        Arch Surg. 2008; 143: 282-287
        • Center for Behavioral Health Statistics and Quality
        Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health.
        2016 (HHS Publication NO. SMA 16-4984 NSDUH Series H-51)
        • Paulozzi L.J.
        • Jones C.M.
        • Mack K.A.
        • Rudd R.A.
        Vital Signs: Overdoses of Prescription Opioid Pain Relievers – United States, 1999-2008. vol. 60. Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Center for Disease Control and Prevention, 2011: 5
        • Rios-Diaz A.J.
        • Herrera-Escobar J.P.
        • Lilley E.J.
        • et al.
        J Trauma Acute Care Surg. 2017; 83: 97-104
        • Holbrook T.L.
        • Anderson J.P.
        • Sieber W.J.
        • Browner D.
        • Hoyt D.
        Outcome after major trauma: 12-month and 18-month follow-up results from the trauma recovery project.
        J Trauma. 1999; 46: 765-773
        • Michaels A.J.
        • Michaels C.E.
        • Smith J.S.
        • Moon C.H.
        • Peterson C.
        • Long W.B.
        Outcome from injury: general health, work status, and satisfaction 12 Months after trauma.
        J Trauma. 2000; 48: 841-850
        • Gabbe B.J.
        • Cameron P.A.
        • Hannaford A.P.
        • Ann M.
        • McNeil J.J.
        Routine follow up of major trauma patients from trauma registries: what are the outcomes?.
        J Trauma. 2006; 61: 1393-1399
        • Colantonio A.
        • Ratcliff G.
        • Chase S.
        • Kelsey S.
        • Escobar M.
        • Vernich L.
        Long term outcomes after moderate to severe traumatic brain injury.
        Disabil Rehabil. 2004; 26: 253-261
        • Frankel H.L.
        • Coll J.R.
        • Charlifue S.W.
        • et al.
        Long-term survival in spinal cord injury: a fifty year investigation.
        Spinal Cord. 1998; 36: 266-274
        • MacKenzie E.J.
        • Bosse M.J.
        Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the lower extremity assessment project (LEAP).
        JAAOS. 2006; 14: 205-210
        • Haider A.H.
        • Herrera-Escobar J.P.
        • Al Rafai S.S.
        • et al.
        Factors associated with long-term outcomes after injury: results of the functional outcomes and recovery after trauma Emergencies (FORTE) multicenter cohort study.
        Ann Surg. 2018;
        • Herrera-Escobar J.P.
        • Al Rafai S.S.
        • Seshadri A.J.
        • et al.
        A multicenter study of post-traumatic stress disorder after injury: mechanism matters more than injury severity.
        Surgeon. 2018; 164: 1246-1250
        • Fenig S.
        • Levav I.
        • Kohn R.
        • Yelin N.
        Telephone vs face-to-face interviewing in a community psychiatric survey.
        Am J Public Health. 1993; 83: 896-898
        • Sturges J.E.
        • Hanrahan K.J.
        Comparing telephone and face-to-face qualitative interviewing: a research note.
        Sage J. 2004; 4: 107-118