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Association of pain after trauma with long-term functional and mental health outcomes

Herrera-Escobar, Juan Pablo, MD, MPH; Apoj, Michel; Weed, Christina, MD, MPH; Harlow, Alyssa Fitzpatrick, MPH; Al Rafai, Syeda Sanam, MD; Lilley, Elizabeth, MD, MPH; Kasotakis, George, MD, MPH; Brasel, Karen, MD, MPH; Kaafarani, Haytham M.A., MD, MPH; Velmahos, George, MD, PhD; Salim, Ali, MD; Haider, Adil Hussain, MD, MPH

Journal of Trauma and Acute Care Surgery: October 2018 - Volume 85 - Issue 4 - p 773–779
doi: 10.1097/TA.0000000000002017
ORIGINAL ARTICLES

BACKGROUND Chronic pain after trauma is associated with serious clinical, social, and economic burden. Due to limitations in trauma registry data and previous studies, the current prevalence of chronic pain after trauma is unknown, and little is known about the association of pain with other long-term outcomes. We sought to describe the long-term burden of self-reported pain after injury and to determine its association with positive screen for posttraumatic stress disorder (PTSD), functional status, and return to work.

METHODS Trauma survivors with moderate or severe injuries and one completed follow-up interview at either 6 months or 12 months after injury were identified from the Functional Outcomes and Recovery after Trauma Emergencies project. Multivariable logistic regression models clustered by facility and adjusting for confounders were used to obtain the odds of positive PTSD screening, not returning to work, and functional limitation at 6 months and 12 months after injury, in trauma patients who reported to have pain on a daily basis compared to those who did not.

RESULTS We completed interviews on 650 patients (43% of eligible patients). Half of patients (50%) reported experiencing pain daily, and 23% reported taking pain medications daily between 6 months and 12 months after injury. Compared to patients without pain, patients with pain were more likely to screen positive for PTSD (odds ratio [OR], 5.12; 95% confidence interval [CI], 2.97–8.85), have functional limitations for at least one daily activity (OR, 2.42; 95% CI, 1.38–4.26]), and not return to work (OR, 1.86; 95% CI, 1.02–3.39).

CONCLUSIONS There is a significant amount of self-reported chronic pain after trauma, which is in turn associated with positive screen for PTSD, functional limitations, and delayed return to work. New metrics for measuring successful care of the trauma patient are needed that span beyond mortality, and it is important we shift our focus beyond the trauma center and toward improving the long-term morbidity of trauma survivors.

LEVEL OF EVIDENCE Therapeutic/Care management, level III.

From the Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health. Boston, Massachusetts (J.P.H.-E., A.F.H., S.S.A.R., E.L., A.H.H.); Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, Boston University School of Medicine. Boston, Massachusetts (M.A., G.K.); Department of Surgery, Virginia Mason Medical Center, Seattle, Washington (C.W.); Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University. Portland, Oregon (K.B.); Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School. Boston, Massachusetts (H.M.K., G.V.); and Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School. Boston, Massachusetts (A.S., A.H.H.).

Submitted: March 12, 2018, Revised: May 10, 2018, Accepted: June 15, 2018, Published online: July 17, 2018.

A portion of this work was presented in the plenary session of the Academic Surgical Congress in Las Vegas, NV, in February 7–9, 2017.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Juan Pablo Herrera-Escobar, MD, Center for Surgery and Public Health, 1620 Tremont St, Suite 4-020, Boston, Massachusetts 02120; email: jherrera@hsph.harvard.edu.

© 2018 Lippincott Williams & Wilkins, Inc.