Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort Study
- Author(s): Beaudoin, Francesca L.
- Zhai, Wanting
- Merchant, Roland C.
- Clark, Melissa A.
- Kurz, Michael C.
- Hendry, Phyllis
- Swor, Robert A.
- Peak, David
- Pearson, Claire
- Domeier, Robert
- Ortiz, Christine
- McLean, Samuel A.
- et al.
Introduction: Blacks in the United States experience greater persistent pain than non-Hispanic Whites acrossa range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factorsor incidence of persistent pain among Blacks experiencing common traumatic stress exposures such asafter a motor vehicle collision (MVC). We evaluated the incidence and predictors of moderate to severe axialmusculoskeletal pain (MSAP) and widespread pain six weeks after a MVC in a large cohort of Black adultspresenting to the emergency department (ED) for care.
Methods: This prospective, multi-center, cohort study enrolled Black adults who presented to one of 13 EDsacross the US within 24 hours of a MVC and were discharged home after their evaluation. Data were collectedat 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 widespreadpain. 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 aboutrecovery, and symptoms of depression.
Conclusion: These data indicate that Blacks presenting to the ED for evaluation after MVCs are at highrisk for persistent and widespread musculoskeletal pain. Preventive interventions are needed to improveoutcomes for this high-risk group.