Chronic Widespread Pain After Motor Vehicle Collisions
Chronic Widespread Pain After Motor Vehicle Collisions
When it comes to the evaluation of the injury victim, consideration must be given the entire body not just specific body regions. A certain portion of the trauma population will present immediately with widespread pain patterns that appear different than regional or local pain syndromes. A recent study by Hu et al (2015) stated, “Population-based studies indicate that 11% to 13% of adults suffer from chronic widespread pain (CWP), defined as pain on both the left and right side of the body, above and below the waist, and including the axial [spine and skull] region. These individuals experience substantial disability and reduced quality of life.” [page 1] This is an important caveat to understand when evaluating patients that have experienced significant traumatic event.
The authors go on to say, “One known trigger of CWP [chronic widespread pain] is motor vehicle collision (MVC)” [page 1] “The results of this study suggest that the pathogenic trajectory of CWP [chronic widespread pain] after MVC is characterized by the immediate development of WP [widespread pain] which persists, rather than the gradual progression of pain from regional to widespread.” [pg. 4] “Approximately, 1 in 5 individuals presenting to the ED after MVC had a CWP trajectory.” [pg. 4] The fact that 20% of patients will show signs of chronic widespread pain is significant and important since the danger of considering them subjectively magnifying their symptoms can be a major mistake in the management of the patient. The authors continue by stating, “Findings of this study supporting a nonrecovery model of CWP [chronic widespread pain] development is consistent with increasing evidence that pain outcomes after stress exposures such as MVC are mediated by central neurobiological mechanisms” [pg. 5] This means that the pain is not just coming from injured connective tissue, but it is modulated by the Central Nervous System. The authors continue by reporting, “These data are consistent with evidence that stress exposure can result in widespread changes in sensory processing because of mechanisms such as the sensitization of peripheral afferents by persistently elevated levels of catecholamines and glucocorticoids and by endogenous opioid-induced hyperalgesia.” [pg. 5] This means that compounds within the body are reacting to the trauma by making the patient more sensitive to pain.
In conclusion, the authors include, “Our finding that crash-related factors such as amount of vehicle damage showed little association with CWP outcomes is also consistent with previous studies, as are results of this study that individuals developing CWP after MVC are much more likely to develop substantial comorbid somatic symptoms, PTSD symptoms, and depressive symptoms.” [pg5] It is critical to work with a team of providers that understand the bodies response to trauma and have the skills and credentials to objectify this type of bodily injury and document its persistent functional losses.
Reference:
1. Hu, J., Bortsov, A. V., Ballina, L., Orrey, D. C., Swor, R. A., Peak, D., ... & Hendry, P. (2016). Chronic widespread pain after motor vehicle collision typically occurs through immediate development and nonrecovery: results of an emergency department-based cohort study. Pain, 157(2), 438-444.
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