title: Prolonged pain and disability are common after rib fractures.
abstract: BACKGROUND
  The contribution of rib fractures to prolonged pain and disability may be underappreciated and undertreated. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6 to 8 weeks.
  
  
  METHODS
  This study was a prospective observation of 203 patients with rib fractures at a level 1 trauma center. Chest wall pain was evaluated by the McGill Pain Questionnaire (MPQ) pain rating index (PRI) and present pain intensity (PPI). Prolonged pain was defined as a PRI of 8 or more at 2 months after injury. Prolonged disability was defined as a decrease in 1 or more levels of work or functional status at 2 months after injury. Predictors of prolonged pain and disability were determined by multivariate analysis.
  
  
  RESULTS
  One hundred forty-five male patients and 58 female patients with a mean injury severity score (ISS) of 20 (range, 1 to 59) had a mean of 5.4 rib fractures (range, 1 to 29). Forty-four (22%) patients had bilateral fractures, 15 (7%) had flail chest, and 92 (45%) had associated injury. One hundred eighty-seven patients were followed 2 months or more. One hundred ten (59%) patients had prolonged chest wall pain and 142 (76%) had prolonged disability. Among 111 patients with isolated rib fractures, 67 (64%) had prolonged chest wall pain and 69 (66%) had prolonged disability. MPQ PPI was predictive of prolonged pain (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4 to 2.5), and prolonged disability (OR, 2.2; 95% CI, 1.5 to 3.4). The presence of significant associated injuries was predictive of prolonged disability (OR, 5.9; 95% CI, 1.4 to 29).
  
  
  CONCLUSIONS
  Prolonged chest wall pain is common, and the contribution of rib fractures to disability is greater than traditionally expected. Further investigation into more effective therapies that prevent prolonged pain and disability after rib fractures is needed.
authors.affiliation: Division of Trauma, Critical Care, & Acute Care Surgery, Department of Surgery, Oregon Health & Science University, L611, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Loic
authors.initials: L
authors.lastname: Fabricant
authors.forename: Bruce
authors.initials: B
authors.lastname: Ham
authors.forename: Richard
authors.initials: R
authors.lastname: Mullins
authors.forename: John
authors.initials: J
authors.lastname: Mayberry
mesh_terms: D003289:Convalescence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D015999:Multivariate Analysis; D059352:Musculoskeletal Pain / Q000209:etiology*; D016017:Odds Ratio; D010147:Pain Measurement; D011446:Prospective Studies; D020127:Recovery of Function; D062707:Return to Work; D012253:Rib Fractures / Q000150:complications* / Q000503:physiopathology; D011795:Surveys and Questionnaires