Early Factors Associated with the Development of Chronic Pain in Trauma Patients

Abstract

Objective To identify factors, available at the time of trauma admission, associated with the development of chronic pain to allow testing of preventive approaches. Methods In a retrospective observational cohort study, we included all patients ≥ 18 years old admitted for injury in 57 adult trauma centers in the province of Quebec (Canada) between 2004 and 2014. Chronic pain was defined as follows: treated in a chronic pain clinic, diagnosed with chronic pain, or received at least 2 prescriptions of chronic pain medications 3 to 12 months postinjury. Results A total of 95,134 patients were retained for analysis. Mean age was 59.8 years (±21.7), and 52% were men. The causes of trauma were falls (63%) and motor vehicle accidents (22%). We identified 14,518 patients (15.3%; 95% CI: 15.1–15.5) who developed chronic pain. After controlling for confounding factors, the variables associated with chronic pain were spinal cord injury (OR = 3.9; 95% CI: 3.4–4.6), disc-vertebra trauma (OR = 1.6; 95% CI: 1.5–1.7), history of alcoholism (OR = 1.4; 95% CI: 1.2–1.7), history of anxiety (OR = 1.4; 95% CI: 1.2–1.5), history of depression (OR = 1.3; 95% CI: 1.1–1.4), and being female (OR = 1.3; 95% CI: 1.2–1.3). The area under the receiving operating characteristic curve derived from the model was 0.80. Conclusions We identified risk factors present on hospital admission that can predict trauma patients who will develop chronic pain. These factors should be prospectively validated.

Chronic Pain following Chest Trauma: Prevalence, Associated Factors, and Psychosocial Impact

“…In addition, the prevalence and characteristics of CP may vary with the severity of anatomical injuries and the extent of tissue damage. us, the prevalence decreased from more than 79% in the study of Trevino et al [29] including violent chest trauma to less than 16% in the study of Daoust et al [7] including less severe chest trauma. Finally, some methodological variability should be considered such as the tool used in pain assessment, the approach considered in data collection and the characteristics of the studied population.…”

“…Indeed, the definitions considered to designate CP have not been consensual at least for the duration required to retain chronicity. is duration varied from 3 months in the study of Rabiou et al [30] and Daoust et al [7] to 4 months in the study of Trevino et al [36] to 6 months in the study of Shelat et al [32] and up to 1 year in the study of Gordy et al [33].…”

“…In a Canadian study conducted in 57 trauma centers over a 10-year period, the CP assessed at the third posttraumatic month in 95134 patients had a prevalence of 15.3% [7].…”

“…is painful experience is well recognized in many medical fields. However, it is still an emerging problem in surgical and trauma contexts despite its effects on postoperative satisfaction and injured patients prognosis [4][5][6][7]. In addition, it seems to have a higher incidence after severe acute painful injuries such as chest trauma which includes any form of physical injury to the chest.…”

Opioid Use and Misuse Three Months After Emergency Department Visit for Acute Pain

“…However, the prevalence of chronic pain reported in this study could very well be higher because some patients may have used medications other than opioids (or other methods altogether) to treat their ongoing pain. Indeed, postsurgical or traumatic pain studies usually report higher prevalence of chronic pain.…”