BACKGROUND The vast majority of individuals who come to the emergency department (ED) for care after a motor vehicle collision (MVC) are diagnosed with musculoskeletal strain only and are discharged to home. A significant subset of this population will still develop persistent pain and posttraumatic psychological sequelae may play an important role in pain persistence. METHODS We conducted a multisite longitudinal cohort study of adverse post-traumatic neuropsychiatric sequelae (APNS) among patients seeking emergency department (ED) treatment in the aftermath of a traumatic life experience. We report on a sub-group of patients (n=666) presenting after an MVC, the most common type of trauma and we examine associations of socio-demographic and MVC characteristics, and persistent pain eight weeks after MVC. We also examine the degree to which these associations are related to peritraumatic psychological symptoms and 2-week acute stress reactions using an applied approach. RESULTS Eight-week prevalence of persistent moderate or severe pain was high (67.4%) and positively associated with patient sex (female), older age, low socioeconomic status (education and income), and pain severity in the ED. Peritraumatic stress symptoms (distress and dissociation) appear to exert some influence on both acute pain and the transition from acute to persistent pain DISCUSSION AND CONCLUSIONS: The early aftermath of an MVC may be an important time period for intervening to prevent and reduce persistent pain. Substantial variation in mediating pathways across predictors also suggests potential diverse and complex underlying biological and psychological pathogenic processes are at work in the early weeks following trauma. SIGNIFICANCE The first several days after trauma may dictate recovery trajectories. Persistent pain, pain lasting beyond the expected time of recovery, is associated with pain early in the recovery period, but also mediated through other pathways. Future work is needed to understand the complex neurobiological processes in involved in the development of persistent and acute post-traumatic pain.

中文翻译：

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机动车碰撞后的疼痛：社会人口统计学、碰撞特征和创伤周围应激症状的作用


背景技术绝大多数在机动车碰撞（MVC）后前往急诊科（ED）接受护理的人仅被诊断为肌肉骨骼拉伤并出院回家。该人群中很大一部分人仍会出现持续性疼痛，而创伤后心理后遗症可能在疼痛持续性中发挥重要作用。方法 我们对因创伤生活经历而寻求急诊科 (ED) 治疗的患者进行了一项多中心纵向队列研究，研究不良的创伤后神经精神后遗症 (APNS)。我们报告了 MVC（最常见的创伤类型）后出现的一组患者 (n=666)，并检查了社会人口统计学和 MVC 特征的关联，以及 MVC 后八周的持续疼痛。我们还使用应用方法检查了这些关联与创伤周围心理症状和两周急性应激反应的相关程度。结果 持续中度或重度疼痛的八周患病率很高（67.4%），并且与患者性别（女性）、年龄较大、社会经济地位较低（教育和收入）以及急诊科疼痛严重程度呈正相关。创伤周围应激症状（痛苦和解离）似乎对急性疼痛以及从急性疼痛到持续性疼痛的转变都有一定影响。 讨论和结论：MVC 的早期后果可能是进行干预以预防和减轻持续性疼痛的重要时间段。跨预测因素的介导途径的巨大差异也表明潜在的多样化和复杂的潜在生物和心理致病过程在创伤后的最初几周内发挥作用。 意义 创伤后的最初几天可能决定康复轨迹。持续性疼痛，即持续超过预期恢复时间的疼痛，与恢复期早期的疼痛有关，但也通过其他途径介导。未来的工作需要了解参与持续性和急性创伤后疼痛发展的复杂神经生物学过程。