PMID- 35843753
OWN - NLM
STAT- MEDLINE
DCOM- 20220926
LR  - 20220926
IS  - 1879-0267 (Electronic)
IS  - 0020-1383 (Linking)
VI  - 53
IP  - 10
DP  - 2022 Oct
TI  - Biopsychosocial sequelae of chronically painful injuries sustained in motor 
      vehicle accidents contributing to non-recovery: A retrospective cohort study.
PG  - 3201-3208
LID - S0020-1383(22)00455-7 [pii]
LID - 10.1016/j.injury.2022.06.046 [doi]
AB  - BACKGROUND: Claimants with chronically painful injuries sustained in motor 
      vehicle accidents (MVAs) undergo assessment and management influenced by 
      insurance and medico-legal processes defined by a biomedical paradigm which is 
      discordant with best evidence. We aim to demonstrate the impact of 
      biopsychosocial factors on post-MVA sequelae which contribute to non-recovery. 
      METHODS: This was a retrospective cohort study of medico-legal documents and 
      reports on 300 consecutive claimants referred to a pain medicine physician over 7 
      years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. 
      One hundred data items were extracted from the medico-legal documents and reports 
      for each claimant and entered into an electronic database. Post-MVA sequelae were 
      analysed using chi-square analysis (OR >2) for significant associations with 
      demographic, pre-MVA and post-MVA variables. Factors with significant 
      associations were entered into a logistic regression model to determine 
      significant statistical predictors of post-MVA sequelae contributing to 
      non-recovery. RESULTS: The claimants were aged 17 to 80 years (mean age 42 
      years), and approximately half (53%, n=159) were female. The time from MVA to 
      interview averaged 2.5 years. Widespread pain was present in 18% (n=54), and 
      widespread somatosensory signs implying central sensitisation (OR=9.85, p<.001) 
      was the most significant multivariate association. Long-term opiate use post-MVA 
      (32%) was predicted by pre-MVA sleep disturbance (OR=5.08, p=.001), post-MVA 
      major depressive disorder (MDD) (OR=3.02, p=.003) and long-term unemployment 
      (OR=2.22. p=.007). Approximately half (47%, n=142) required post-MVA support from 
      a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was 
      diagnosed by a psychiatrist or psychologist in 20% (n=59), yet early 
      identification of risk of PTSD was rare. Pre-MVA, 89.4% (n=268) were studying or 
      employed. Permanent unemployability post-MVA occurred in 35% (n=104) and was 
      predicted by MDD (OR=3.59, p=.001) and antidepressant use (OR=2.17, p=.005). 
      Major social change post-MVA (70%) was predicted by older age (OR=.966, p=.003), 
      depressive symptoms (OR=3.71, p<.001) and opiate use (OR=2.00, p=.039). 
      CONCLUSIONS: Biomedical factors, including older age, impaired sleep and 
      indicators of widespread central sensitisation, and psychological factors, 
      including stress, anxiety and depression, were the most prominent multivariate 
      associations as statistical predictors of major adverse sequelae contributing to 
      non-recovery for claimants with chronic pain post-MVA.
CI  - Copyright (c) 2022. Published by Elsevier Ltd.
FAU - Tan, Aidan Christopher
AU  - Tan AC
AD  - School of Women's and Children's Health, University of New South Wales, Sydney, 
      NSW, Australia. Electronic address: aidan.tan@unsw.edu.au.
FAU - Allen, Samantha Kate
AU  - Allen SK
AD  - Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, NSW, Australia. 
      Electronic address: samantha.allen2@health.nsw.gov.au.
FAU - Aziz, Iqra
AU  - Aziz I
AD  - Royal North Shore Hospital, Sydney, NSW, Australia. Electronic address: 
      iqra.aziz@health.nsw.gov.au.
FAU - Mercado, Melanie
AU  - Mercado M
AD  - St George Hospital, Sydney, NSW, Australia. Electronic address: 
      mel.cado26@gmail.com.
FAU - Nanthakumar, Keshini
AU  - Nanthakumar K
AD  - Blacktown and Mount Druitt Hospital, Sydney, NSW, Australia. Electronic address: 
      keshi96@gmail.com.
FAU - Syed, Faisal
AU  - Syed F
AD  - Wollongong Hospital, Sydney, NSW, Australia. Electronic address: 
      faisal.syed1@health.nsw.gov.au.
FAU - Champion, G David
AU  - Champion GD
AD  - School of Women's and Children's Health, Department of Pain, University of New 
      South Wales, Sydney, Level 7 Bright Alliance Building, High Street, Randwick, NSW 
      2031, Australia. Electronic address: dchamp@bigpond.net.au.
LA  - eng
PT  - Journal Article
DEP - 20220702
PL  - Netherlands
TA  - Injury
JT  - Injury
JID - 0226040
RN  - 0 (Opiate Alkaloids)
SB  - IM
MH  - Accidents, Traffic/psychology
MH  - Adult
MH  - *Depressive Disorder, Major
MH  - Female
MH  - Humans
MH  - Male
MH  - Motor Vehicles
MH  - *Opiate Alkaloids
MH  - Pain
MH  - Retrospective Studies
MH  - *Stress Disorders, Post-Traumatic/diagnosis/epidemiology/etiology
OTO - NOTNLM
OT  - Chronic pain
OT  - Mental health
OT  - Motor vehicle accidents
OT  - Social change
OT  - Work
OT  - sleep disturbance
COIS- Declaration of Competing Interest The authors declare no relationships or 
      activities that could appear to have influenced the submitted work.
EDAT- 2022/07/18 06:00
MHDA- 2022/09/28 06:00
CRDT- 2022/07/17 22:04
PHST- 2022/04/05 00:00 [received]
PHST- 2022/06/30 00:00 [accepted]
PHST- 2022/07/18 06:00 [pubmed]
PHST- 2022/09/28 06:00 [medline]
PHST- 2022/07/17 22:04 [entrez]
AID - S0020-1383(22)00455-7 [pii]
AID - 10.1016/j.injury.2022.06.046 [doi]
PST - ppublish
SO  - Injury. 2022 Oct;53(10):3201-3208. doi: 10.1016/j.injury.2022.06.046. Epub 2022 
      Jul 2.