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Trauma patients likely to experience moderately severe pain 1 year after injuries

The JAMA Network Journals

Most patients have moderately severe pain resulting from their injuries one year after sustaining major trauma, according to a report in the March issue of Archives of Surgery, one of the JAMA/Archives journals.

"Pain is a natural accompaniment of acute injury to tissues and is expected in the setting of acute trauma," according to background information in the article. Recent studies have shown that most patients with pelvic fractures and lower extremity injuries continue to experience chronic pain five to seven years after injury. Pain after injury can lead to disability, post-traumatic stress disorder and depression.

Frederick P. Rivara, M.D., M.P.H., of the University of Washington, Seattle, and colleagues analyzed information from 3,047 patients (age 18 to 84) who were admitted to the hospital and survived to one year after experiencing acute trauma. Pain 12 months after injury was measured on a 10-point scale. Personal, injury and treatment factors that may predict chronic pain in these patients were also noted.

"At 12 months after injury, 62.7 percent of patients reported injury-related pain. Most patients had pain in more than one body region, and the mean [average] severity of pain in the last month was 5.5 on a 10-point scale," the authors write. The occurrence of pain one year after injury was most common in those age 35 to 44 and least common in those 75 to 84. "The most common painful areas were joints and extremities (44.3 percent), back (26.2 percent), head (11.5 percent), neck (6.9 percent), abdomen (4.4 percent), chest (3.8 percent) and face (2.8 percent)."

Most (59.3 percent) of those with injury-related pain had three or more painful areas one year after injury, while only 37.3 percent had a single painful area. Patients age 75 to 84 had the fewest number of injury-related painful areas, while those 35 to 44 had the most.

"The reported presence of pain varied with age and was more common in women and those who had untreated depression before injury," the authors write. "Pain at three months was predictive of both the presence and higher severity of pain at 12 months. Lower pain severity was reported by patients with a college education and those with no previous functional limitations."

"The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed," the authors conclude. "The high prevalence of pain, its severity and its effect on functioning warrant such interventions. This may consist of interventions during the acute phase of hospitalization to aggressively treat early pain and better manage neuropathic pain."

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(Arch Surg. 2008;143[3]:282-287. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was funded by a grant from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, and a grant from the National Institute on Aging, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

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