Most patients have moderately severe pain resulting from their injuries one year after sustaining major trauma, according to a new article. "Pain is a natural accompaniment of acute injury to tissues and is expected in the setting of acute trauma," according to background information in the [JAMA Archives of Surgery] article.
Recent studies have shown that most patients with pelvic fractures and lower extremity injuries continue to experience chronic pain five to seven years after injury. Pain after injury can lead to disability, post-traumatic stress disorder and depression.
In educational interest, article(s) quoted from extensively.
Frederick P. Rivara, M.D., M.P.H., of the University of Washington, Seattle, and colleagues analyzed information from 3,047 patients (age 18 to 84) who were admitted to the hospital and survived to one year after experiencing acute trauma. Pain 12 months after injury was measured on a 10-point scale. Personal, injury and treatment factors that may predict chronic pain in these patients were also noted.
"At 12 months after injury, 62.7 percent of patients reported injury-related pain. Most patients had pain in more than one body region, and the mean [average] severity of pain in the last month was 5.5 on a 10-point scale," the authors write. The occurrence of pain one year after injury was most common in those age 35 to 44 and least common in those 75 to 84. "The most common painful areas were joints and extremities (44.3 percent), back (26.2 percent), head (11.5 percent), neck (6.9 percent), abdomen (4.4 percent), chest (3.8 percent) and face (2.8 percent)." ...
"The reported presence of pain varied with age and was more common in women and those who had untreated depression before injury," the authors write. "Pain at three months was predictive of both the presence and higher severity of pain at 12 months. Lower pain severity was reported by patients with a college education and those with no previous functional limitations."
"The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed," the authors conclude. "The high prevalence of pain, its severity and its effect on functioning warrant such interventions. This may consist of interventions during the acute phase of hospitalization to aggressively treat early pain and better manage neuropathic pain."
General information on trauma and pain from BBC News:
In the Archives of Surgery journal, the University of Washington team called for more intervention to control pain as swiftly as possible. UK patients face the same problems, said one specialist physiotherapist. A report published in 2004 suggested that the quality of chronic pain management in primary care, and the amount offered to patients, was "highly variable".
Only one in 25 of those primary care trusts which replied said that they were even trying to record how many patients they had suffering from chronic pain. The US finding clearly sets out the burden of long-term pain on those suffering traumatic injuries.
The patients in their survey were aged between 18 and 84, who had all survived at least one year after their accident. After 12 months, they were asked to rate their pain on a 10-point scale, and almost two-thirds said they were still in pain, often in more than one part of the body. The average level of pain was not excruciating, but still severe - a rating of 5.5 on the scale. Three or more painful areas were reported by 59% of those with injury-related pain.
The researchers wrote: "The presence of pain varied with age, and was more common in women and those who had untreated depression before injury. "Pain at three months was predictive of both the presence and higher severity of pain at 12 months. "The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed."
They suggested that more work at the time of the injury to deal with "early pain" might be effective. Peter Gladwell, a specialist physiotherapist with an interest in pain management, and a member of the Physiotherapy Pain Association, said that research findings were consistent with his experiences with patients.
"Chronic pain can have a devastating effect on patients, on all kinds of areas of their lives. "It's pretty well understood now that any delay in getting specialist opinion on pain management is unhelpful, and our waiting times are nowhere near as long as they were. "There is plenty of evidence that early, good quality, pain relief can improve the outcome for patients."