Citation

Feinberg RK, Hu J, Weaver MA, Fillingim RB, Swor RA, Peak DA, Jones JS, Rathlev NK, Lee DC, Domeier RM, Hendry PL, Liberzon I, McLean SA. Pain 2016; 158(4): 682-690.

Affiliation

a TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC, USA b Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA c Departments of Medicine and Biostatistics, University of North Carolina, Chapel Hill, NC, USA d Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA e Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA f Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA g Department of Emergency Medicine, Spectrum Health System, Grand Rapids, MI, USA h Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA i Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA j Department of Emergency Medicine, Saint Joseph Mercy Health System, Ypsilanti, MI, USA k Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA l Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA m Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA.

Copyright

(Copyright © 2016, Lippincott, Williams and Wilkins)

DOI

10.1097/j.pain.0000000000000818

PMID

28030471

Abstract

Post-traumatic stress disorder (PTSD) symptoms and pain after traumatic events such as motor vehicle collision (MVC) have been proposed to be mutually promoting. We performed a prospective multicenter study that enrolled 948 individuals who presented to the emergency department (ED) within 24 hours of MVC and were discharged home after evaluation. Follow-up evaluations were completed 6 weeks, 6 months, and 1 year after MVC. Path analysis results supported the hypothesis that axial pain after MVC consistently promotes the maintenance of hyperarousal and intrusive symptoms, from the early weeks post-injury through 1 year. In addition, path analysis results supported the hypothesis that one or more PTSD symptom clusters had an influence on axial pain outcomes throughout the year after MVC, with hyperarousal symptoms most influencing axial pain persistence in the initial months after MVC. The influence of hyperarousal symptoms on pain persistence was only present among individuals with genetic vulnerability to stress-induced pain, suggesting specific mechanisms by which hyperarousal symptoms may lead to hyperalgesia and allodynia. Further studies are needed to better understand the specific mechanisms by which pain and PTSD symptoms enhance one another after trauma, and how such mechanisms vary among specific patient subgroups, to better inform the development of secondary preventive interventions.

Language: en