C. Velmahos1, J. P. Herrera-Escobar2, S. S. Al Rafai2, J. M. Lee1, R. Rivero3, M. Apoj3, H. M. Kaafarani1, G. Kasotakis3, A. Salim2, D. Nehra2, A. H. Haider2 1Massachusetts General Hospital,Boston, MA, USA 2Brigham And Women’s Hospital,Boston, MA, USA 3Boston University,Boston, MA, USA
Introduction: Chronic pain after major trauma decreases productivity, impedes functional recovery, and increases health care costs. Early identification of trauma patients at higher risk of developing chronic pain may lead to interventions that improve long-term outcomes. The aim of the study was to identify early predictors of chronic pain and long-term use of pain medications after major trauma.
Methods: We interviewed major trauma patients (Injury Severity Score ≥ 9) from three level I trauma centers at 6- and 12-months after injury. We evaluated the presence of daily pain using the Trauma Quality of Life questionnaire and used multivariate logistic regression models to identify patient- and injury-related independent predictors of chronic pain and use of pain medications 6-12 months after injury. The models included demographics, educational level, injury characteristics, hospital course variables, and accounted for correlation within trauma center. The three most significant predictors of chronic pain after major trauma were identified based on the highest coefficients and were used to create a probability table predicting chronic pain.
Results: Of 608 patients interviewed, 304 (50%) reported to have pain daily and 140 (23%) were taking pain medications daily. Among those who reported having pain, 40% reported to take pain medications. Age < 65 [OR: 2.63 (95% CI: 1.78-3.89)], high school or lower education [OR: 1.52 (95% CI: 1.04-2.17)], motor-vehicle crash (MVC) [OR: 1.71 (95% CI: 1.09-2.64)], work-related injuries [OR: 2.96 (95% CI: 1.21-7.22)], discharge to rehabilitation [OR: 2.11 (95% CI: 1.31-3.39)], and increased hospital stay [OR: 1.04 (95% CI: 1.01-1.07)] were significant independent predictors of chronic pain after major trauma. On the other hand, high school or lower education [OR: 1.91 (95% CI: 1.22-3.00)], falls [OR: 1.97 (95% CI: 1.14-3.40)], and discharge to rehabilitation [OR: 1.77 (95% CI: 1.01-3.11)] were significant predictors of chronic pain medication usage post-trauma. The three most significant independent predictors together augmented the probability of chronic pain in patients after trauma, as shown in the Table.
Conclusion: Age, educational level, MVC, work-related injuries, discharge disposition, and hospital length of stay were identified as early predictors of chronic pain after major trauma. Similarly, educational level, discharge disposition, and falls predicted chronic use of pain medications. Identifying patients at higher risk for chronic pain and usage of pain medications can be used to offer appropriate clinical services and closely monitor patients’ pain and its treatment.
