Association of Pain after Trauma with Long-term Functional and Mental Health Outcomes

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 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- or 12-months post-injury were identified from the Functional Outcomes and Recovery after Trauma Emergencies (FORTE) 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- 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- and 12-months post-injury. Compared to patients without pain, patients with pain were more likely to screen positive for PTSD (OR: 5.12 [2.97-8.85]), have functional limitations for at least one daily activity (OR: 2.42 [1.38-4.26]), and not return to work (OR: 1.86 [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 towards improving the long-term morbidity of trauma survivors. Level of Evidence Level III - Therapeutic/Care Management Corresponding author: Juan Pablo Herrera-Escobar, Center for Surgery and Public Health, 1620 Tremont Street, Suite 4-020, Boston, Massachusetts 02120. Email: jherrera@hsph.harvard.edu. Phone: 617- 378-8165 Meeting presentation A portion of this work was presented in the Plenary Session of the Academic Surgical Congress in Las Vegas, NV. February, 2017. Financial Support: The present work was funded by the Center for Surgery and Public Health own resources. Conflicts of interest: None © 2018 Lippincott Williams & Wilkins, Inc.

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