title: Incidence and predictors of neck and widespread pain after motor vehicle collision among US litigants and nonlitigants.
abstract: Debate continues regarding the influence of litigation on pain outcomes after motor vehicle collision (MVC). In this study we enrolled European Americans presenting to the emergency department (ED) in the hours after MVC (n=948). Six weeks later, participants were interviewed regarding pain symptoms and asked about their participation in MVC-related litigation. The incidence and predictors of neck pain and widespread pain 6weeks after MVC were compared among those engaged in litigation (litigants) and those not engaged in litigation (nonlitigants). Among the 859 of 948 (91%) participants completing 6-week follow-up, 711 of 849 (83%) were nonlitigants. Compared to nonlitigants, litigants were less educated and had more severe neck pain and overall pain, and a greater extent of pain at the time of ED evaluation. Among individuals not engaged in litigation, persistent pain 6weeks after MVC was common: 199 of 711 (28%) had moderate or severe neck pain, 92 of 711 (13%) had widespread pain, and 29 of 711 (4%) had fibromyalgia-like symptoms. Incidence of all 3 outcomes was significantly higher among litigants. Initial pain severity in the ED predicted pain outcomes among both litigants and nonlitigants. Markers of socioeconomic disadvantage predicted worse pain outcomes in litigants but not nonlitigants, and individual pain and psychological symptoms were less predictive of pain outcomes among those engaged in litigation. These data demonstrate that persistent pain after MVC is common among those not engaged in litigation, and provide evidence for bidirectional influences between pain outcomes and litigation after MVC.
authors.affiliation: TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC, USA Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA School of Dentistry, University of North Carolina, Chapel Hill, NC, USA Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA Department of Emergency Medicine, Spectrum Health System, Grand Rapids, MI, USA Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA Department of Emergency Medicine, Saint Joseph Mercy Health System, Ypsilanti, MI, USA Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: McLean
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Ulirsch
authors.forename: Gary D
authors.initials: GD
authors.lastname: Slade
authors.forename: April C
authors.initials: AC
authors.lastname: Soward
authors.forename: Robert A
authors.initials: RA
authors.lastname: Swor
authors.forename: David A
authors.initials: DA
authors.lastname: Peak
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Jones
authors.forename: Niels K
authors.initials: NK
authors.lastname: Rathlev
authors.forename: David C
authors.initials: DC
authors.lastname: Lee
authors.forename: Robert M
authors.initials: RM
authors.lastname: Domeier
authors.forename: Phyllis L
authors.initials: PL
authors.lastname: Hendry
authors.forename: Andrey V
authors.initials: AV
authors.lastname: Bortsov
authors.forename: Eric
authors.initials: E
authors.lastname: Bair
mesh_terms: D000063:Accidents, Traffic / Q000331:legislation & jurisprudence* / Q000523:psychology / Q000639:trends; D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007603:Jurisprudence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D014911:Whiplash Injuries / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult
keywords: Jurisprudence; Legislation; Motor vehicle collision; Musculoskeletal pain; Neck pain; Whiplash injuries