title: Stress-related psychological symptoms contribute to axial pain persistence after motor vehicle collision: path analysis results from a prospective longitudinal study.
abstract: Posttraumatic stress disorder (PTSD) symptoms and pain after traumatic events such as motor vehicle collision (MVC) have been proposed to be mutually promoting. We performed a prospective multicenter study that enrolled 948 individuals who presented to the emergency department within 24 hours of MVC and were discharged home after evaluation. Follow-up evaluations were completed 6 weeks, 6 months, and 1 year after MVC. Path analysis results supported the hypothesis that axial pain after MVC consistently promotes the maintenance of hyperarousal and intrusive symptoms, from the early weeks after injury through 1 year. In addition, path analysis results supported the hypothesis that one or more PTSD symptom clusters had an influence on axial pain outcomes throughout the year after MVC, with hyperarousal symptoms most influencing axial pain persistence in the initial months after MVC. The influence of hyperarousal symptoms on pain persistence was only present among individuals with genetic vulnerability to stress-induced pain, suggesting specific mechanisms by which hyperarousal symptoms may lead to hyperalgesia and allodynia. Further studies are needed to better understand the specific mechanisms by which pain and PTSD symptoms enhance one another after trauma, and how such mechanisms vary among specific patient subgroups, to better inform the development of secondary preventive interventions.
authors.affiliation: UNC Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA.|Departments of Anesthesiology and.
authors.forename: Rose K
authors.initials: RK
authors.lastname: Feinberg
authors.affiliation: UNC Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA.|Departments of Anesthesiology and.
authors.forename: JunMei
authors.initials: J
authors.lastname: Hu
authors.affiliation: Medicine and Biostatistics, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
authors.affiliation: Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Fillingim
authors.affiliation: Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Swor
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Peak
authors.affiliation: Department of Emergency Medicine, Spectrum Health System, Grand Rapids, MI, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Jones
authors.affiliation: Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA.
authors.forename: Niels K
authors.initials: NK
authors.lastname: Rathlev
authors.affiliation: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Saint Joseph Mercy Health System, Ypsilanti, MI, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Domeier
authors.affiliation: Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA.
authors.forename: Phyllis L
authors.initials: PL
authors.lastname: Hendry
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Israel
authors.initials: I
authors.lastname: Liberzon
authors.affiliation: UNC Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA.|Departments of Anesthesiology and.|Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: McLean
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology* / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005163:Factor Analysis, Statistical; D005260:Female; D060005:Genotyping Techniques; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000235:genetics / Q000523:psychology*; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000235:genetics / Q000523:psychology; D022021:Tacrolimus Binding Proteins / Q000235:genetics; D013997:Time Factors; D055815:Young Adult; D000099159:Tacrolimus Binding Protein 5
chemical_list: D022021:Tacrolimus Binding Proteins; D000099159:Tacrolimus Binding Protein 5