Development of chronic pain following severe accidental injury. Results of a 3-year follow-up study.
OBJECTIVE
Motor vehicle accidents (MVA) and work-related injuries are two of the more common causes of chronic pain. Nevertheless, there is little evidence on predicting factors regarding the development of chronic pain following physical injury.


METHODS
The present study investigated temporal associations between accident-related factors, psychological factors [symptoms of posttraumatic stress disorder (PTSD), anxiety, depression, coping], and the development of chronic pain in a sample of individuals who had sustained severe accidental injuries (N=90). Assessments were performed within 1 month of the accident, and at 6, 12, and 36 months post trauma.


RESULTS
A total of 40 individuals (44%) reported accident-related pain 3 years after the accident. Individuals with chronic pain showed significantly more symptoms of PTSD, depression, and anxiety, more disability, and more days off work. Analysis of temporal associations between psychological variables and the development of chronic pain indicated that the separation of the pain from the nonpain group mostly occurred between 6 (T2) and 12 months (T3). Differences were much less pronounced at T1.


CONCLUSIONS
The prevalence of chronic pain in severely injured patients 3 years after the accident is considerably high. The development of chronic pain is more related to psychological factors, particularly PTSD symptoms, in the aftermath of the accident, as compared to sociodemographic and accident-related variables at the time of the accident. These findings may be helpful to elucidate the problems in predicting chronic pain conditions in injured subjects and to recognize the onset of a chronic pain condition more reliably.
Jenewein
Josef
J
Department of Psychiatry, University Hospital, Zurich, Switzerland. josef.jenewein@usz.ch
Moergeli
Hanspeter
H
Wittmann
Lutz
L
Büchi
Stefan
S
Kraemer
Bernd
B
Schnyder
Ulrich
U
D000063:Accidents, Traffic / Q000523:psychology*; D000328:Adult; D001007:Anxiety / Q000150:complications / Q000523:psychology*; D002908:Chronic Disease; D003863:Depression / Q000150:complications / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement / Q000379:methods; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors