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Am J Surg. 2019 Apr 1. pii: S0002-9610(19)30142-4. doi: 10.1016/j.amjsurg.2019.03.022. [Epub ahead of print]

It still hurts! Persistent pain and use of pain medication one year after injury.

Author information

1
Department of Biology, Massachusetts Institute of Technology, Cambridge, MA USA; Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School Boston, MA USA. Electronic address: velmahos@mit.edu.
2
Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA.
3
Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School Boston, MA USA.
4
Department of Surgery, Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston University School of Medicine, Boston, MA USA.

Abstract

BACKGROUND:

Given the scarce literature data on chronic post-traumatic pain, we aim to identify early predictors of long-term pain and pain medication use after major trauma.

METHODS:

Major trauma patients (Injury Severity Score ≥ 9) from three Level I Trauma Centers at 12 months after injury were interviewed for daily pain using the Trauma Quality of Life questionnaire. Multivariate logistic regression models identified patient- and injury-related independent predictors of pain and use of pain medication.

RESULTS:

Of 1238 patients, 612 patients (49%) felt daily pain and 300 patients (24%) used pain medication 1 year after injury. Of a total of 8 independent predictors for chronic pain and 9 independent predictors for daily pain medication, 4 were common (pre-injury alcohol use, pre-injury drug use, hospital stay ≥ 5 days, and education limited to high school). Combinations of independent predictors yielded weak predictability for both outcomes, ranging from 20% to 72%.

CONCLUSIONS:

One year after injury, approximately half of trauma patients report daily pain and one-fourth use daily pain medication. These outcomes are hard to predict.

KEYWORDS:

Chronic pain; Pain medication; Patient outcomes; Trauma

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