Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort Study
Introduction: Blacks in the United States experience greater persistent pain than non-Hispanic Whites across a range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factors or incidence of persistent pain among Blacks experiencing common traumatic stress ex...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2020-12-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/93k0958p |
| _version_ | 1819122265309052928 |
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| author | Francesca L. Beaudoin Wanting Zhai Roland C. Merchant Melissa A. Clark Michael C. Kurz Phyllis Hendry Robert A. Swor David Peak Claire Pearson Robert Domeier Christine Ortiz Samuel A. McLean |
| author_facet | Francesca L. Beaudoin Wanting Zhai Roland C. Merchant Melissa A. Clark Michael C. Kurz Phyllis Hendry Robert A. Swor David Peak Claire Pearson Robert Domeier Christine Ortiz Samuel A. McLean |
| author_sort | Francesca L. Beaudoin |
| collection | DOAJ |
| description | Introduction: Blacks in the United States experience greater persistent pain than non-Hispanic Whites across a range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factors or incidence of persistent pain among Blacks experiencing common traumatic stress exposures such as after a motor vehicle collision (MVC). We evaluated the incidence and predictors of moderate to severe axial musculoskeletal pain (MSAP) and widespread pain six weeks after a MVC in a large cohort of Black adults presenting to the emergency department (ED) for care. Methods: This prospective, multi-center, cohort study enrolled Black adults who presented to one of 13 EDs across the US within 24 hours of a MVC and were discharged home after their evaluation. Data were collected at 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 widespread pain. 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 about recovery, and symptoms of depression. Conclusion: These data indicate that Blacks presenting to the ED for evaluation after MVCs are at high risk for persistent and widespread musculoskeletal pain. Preventive interventions are needed to improve outcomes for this high-risk group. |
| first_indexed | 2024-12-22T06:49:42Z |
| format | Article |
| id | doaj.art-7db7acc736a64dd3b6bfd1ddc7ba1575 |
| institution | Directory Open Access Journal |
| issn | 1936-9018 |
| language | English |
| last_indexed | 2024-12-22T06:49:42Z |
| publishDate | 2020-12-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-7db7acc736a64dd3b6bfd1ddc7ba15752022-12-21T18:35:11ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182020-12-0122210.5811/westjem.2020.8.47450wjem-22-139Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort StudyFrancesca L. Beaudoin0Wanting Zhai1Roland C. Merchant2Melissa A. Clark3Michael C. Kurz4Phyllis Hendry5Robert A. Swor6David Peak7Claire Pearson8Robert Domeier9Christine Ortiz10Samuel A. McLean11Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode IslandWarren Alpert Medical School of Brown University, Department of Biostatistics, Providence, Rhode IslandHarvard Medical School, Department of Emergency Medicine, Boston, MassachusettsWarren Alpert Medical School of Brown University, Department of Obstetrics and Gynecology, Providence, Rhode IslandUniversity of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, AlabamaUniversity of Florida College of Medicine – Jacksonville, Department of Emergency Medicine, Jacksonville, FloridaOakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, MichiganHarvard Medical School, Department of Emergency Medicine, Boston, MassachusettsWayne State University School of Medicine, Department of Emergency Medicine, Detroit, MichiganSt. Joseph Mercy Hospital, Department of Emergency Medicine, Ypsilanti, MichiganRhode Island Hospital, Department of Emergency Medicine, Providence, Rhode IslandUniversity of North Carolina – Chapel Hill, Department of Anesthesiology and Emergency Medicine, Chapel Hill, North CarolinaIntroduction: Blacks in the United States experience greater persistent pain than non-Hispanic Whites across a range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factors or incidence of persistent pain among Blacks experiencing common traumatic stress exposures such as after a motor vehicle collision (MVC). We evaluated the incidence and predictors of moderate to severe axial musculoskeletal pain (MSAP) and widespread pain six weeks after a MVC in a large cohort of Black adults presenting to the emergency department (ED) for care. Methods: This prospective, multi-center, cohort study enrolled Black adults who presented to one of 13 EDs across the US within 24 hours of a MVC and were discharged home after their evaluation. Data were collected at 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 widespread pain. 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 about recovery, and symptoms of depression. Conclusion: These data indicate that Blacks presenting to the ED for evaluation after MVCs are at high risk for persistent and widespread musculoskeletal pain. Preventive interventions are needed to improve outcomes for this high-risk group.https://escholarship.org/uc/item/93k0958p |
| spellingShingle | Francesca L. Beaudoin Wanting Zhai Roland C. Merchant Melissa A. Clark Michael C. Kurz Phyllis Hendry Robert A. Swor David Peak Claire Pearson Robert Domeier Christine Ortiz Samuel A. McLean Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort Study Western Journal of Emergency Medicine |
| title | Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort Study |
| title_full | Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort Study |
| title_fullStr | Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort Study |
| title_full_unstemmed | Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort Study |
| title_short | Persistent and Widespread Pain Among Blacks Six Weeks after MVC: Emergency Department-based Cohort Study |
| title_sort | persistent and widespread pain among blacks six weeks after mvc emergency department based cohort study |
| url | https://escholarship.org/uc/item/93k0958p |
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