Citation

Ulirsch JC, Weaver MA, Bortsov AV, Soward AC, Swor RA, Peak DA, Jones JS, Rathlev NK, Lee DC, Domeier RM, Hendry PL, McLean SA. Pain 2014; 155(10): 2116-2123.

Affiliation

TRYUMPH Research Program; Anesthesiology, University of North Carolina, Chapel Hill, North Carolina; Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina. Electronic address: smclean@aims.unc.edu.

Copyright

(Copyright © 2014, Lippincott, Williams and Wilkins)

DOI

10.1016/j.pain.2014.07.025

PMID

25107859

Abstract

Living in a lower socioeconomic status neighborhood has been shown to alter stress system function and is associated with a number of adverse health outcomes, but its influence on musculoskeletal pain (MSP) outcomes after traumatic stress exposures such as motor vehicle collision (MVC) has not been assessed. We performed a multicenter, prospective study that enrolled 948 European-American individuals within 24 hours of MVC who were discharged home after ED evaluation. Follow-up evaluations were completed via telephone or internet survey six weeks, six months, and one year after MVC on 91%, 89%, and 91% of participants, respectively. A robust aggregate measure of census tract neighborhood disadvantage was derived, and individual-level characteristics assessed included socioeconomic and demographic characteristics, pain prior to MVC, litigation status, and opioid use. MSP was assessed in the ED, MSP and pain interference with daily activity were assessed at six weeks, six months, and one year. After adjustment for individual-level factors, living in more disadvantaged neighborhoods was associated with increased MSP (p=0.0009) and increased pain interference with daily function (p<0.0001). The relationship between neighborhood disadvantage and MSP was moderated by a common single nucleotide polymorphism, rs2817038, 5' of the gene encoding FKBP5, a functional regulator of glucocorticoid receptor sensitivity (interaction p-value=0.0015). These data support the hypothesis that low nSES increases the likelihood of worse MSP outcomes after traumatic stress exposures such as MVC, and that this influences is mediated in part via its influence on stress system function.

Language: en