Estimating Risk of Chronic Pain and Disability Following Musculoskeletal Trauma in the United Kingdom

Abstract

ImportanceSerious traumatic injury is a leading cause of death and disability globally, with most survivors known to develop chronic pain.ObjectiveTo describe early variables associated with poor long-term outcome for posttrauma pain and create a clinical screening tool for this purpose.Design, Setting, and ParticipantsThis was a prospective cohort study at a major trauma center hospital in England. Recruitment commenced in December 2018 and ceased in March 2020. Participants were followed up for 12 months. Patients aged 16 years or older who were hospitalized because of acute musculoskeletal trauma within the preceding 14 days were included. Data were analyzed from March to December 2021.ExposureAcute musculoskeletal trauma requiring admittance to a major trauma center hospital.Main Outcomes and MeasuresA poor outcome was defined as Chronic Pain Grade II or higher and measured at both 6 months (primary time point) and 12 months. A broad range of candidate variables potentially associated with outcomes were used, including surrogates for pain mechanisms, quantitative sensory testing, and psychosocial factors. Univariable models were used to identify the variables most likely to be associated with poor outcome, which were entered into multivariable models. A clinical screening tool (nomogram) was derived from 6-month results.ResultsIn total, 1590 consecutive patients were assessed for eligibility, of whom 772 were deemed eligible and 124 (80 male [64.5%]; mean [SD] age, 48.9 [18.8] years) were recruited. At 6 months, 19 of 82 respondents (23.2%) reported a good outcome, whereas at 12 months 27 of 44 respondents (61.4%) reported a good outcome. At 6 months on univariable analysis, an increase in total posttraumatic stress symptoms (odds ratio [OR], 2.09; 95% CI, 1.33-3.28), pain intensity average (OR, 2.87; 95% CI, 1.37-6.00), number of fractures (OR, 2.79; 95% CI, 1.02-7.64), and pain extent (OR, 4.67; 95% CI, 1.57-13.87) were associated with worse outcomes. A multivariable model including those variables had a sensitivity of 0.93, a specificity of 0.54, and C-index of 0.92.Conclusions and RelevanceA poor long-term pain outcome from musculoskeletal traumatic injuries may be estimated by measures recorded within days of injury. These findings suggest that posttraumatic stress symptoms, pain spatial distribution, perceived average pain intensity, and number of fractures are good candidates for a sensitive multivariable model and derived clinical screening tool.

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Pain after combat injury in male UK military personnel deployed to Afghanistan

“…Pain is prevalent after traumatic injury in both military 1 , 2 , 3 , 4 and civilian settings 5 , 6 , 7 , 8 , 9 and can impact the ability to engage with effective rehabilitation and return to employment. 10 During the UK military deployment to Afghanistan (Operation HERRICK 2002–14), blast injury and small arms fire accounted for a significant proportion of traumatic admissions to field hospitals with limb, head, and spinal injuries predominating. 11 , 12 In previous conflicts, blast injuries would often be fatal, either directly or as a result of infection or sepsis, however, modern advances in battlefield medicine and trauma resuscitation have led to increased survival of casualties with complex rehabilitation needs, including pain management.…”