A Prospective Cohort Study

Annals of Emergency Medicine February 2016; Vol. 67; No. 2; pp. 166-176

Timothy F. Platts-Mills, MD; Sean A. Flannigan; Andrey V. Bortsov, PhD; Samantha Smith; Robert M. Domeier, MD; Robert A. Swor, DO; Phyllis L. Hendry, MD; David A. Peak, MD; Niels K. Rathlev, MD; Jeffrey S. Jones, MD; David C. Lee, MD; Francis J. Keefe, PhD; Philip D. Sloane, MD, MPH; Samuel A. McLean, MD: The primary author is from the University of North Carolina. This study cites 56 references.

As the number of older drivers involved in motor vehicle crashes is projected to double over the next two decades, it becomes imperative to unravel the intricate web of persistent pain and its consequences in this vulnerable demographic. A prospective study, encompassing 161 older adults aged 65 years or older, evaluated the incidence, risk factors, and repercussions of persistent pain following motor vehicle crashes. This exploration, conducted across eight emergency departments in four no-fault insurance states, sheds light on a crucial yet often overlooked facet of geriatric healthcare.

1. Unveiling the Landscape of Persistent Pain

  • Persistent back and neck pain, known to be common and disabling among younger adults in the aftermath of motor vehicle crashes, emerges as a substantial concern for older adults as well.
  • The estimated cost of persistent pain in the United States alone is a staggering $29 billion.
  • Increased age is identified as a significant risk factor for the persistence of motor vehicle crash-related pain.

2. The Rising Tide of Motor Vehicle Crashes in Older Adults

  • Motor vehicle crashes stand as the second most common form of traumatic injury among individuals aged 65 years and older, leading to approximately 250,000 emergency department visits annually.
  • The aging demographic poses a unique challenge for safe and effective pharmacologic management of acute pain, making the prevention of persistent pain particularly crucial.

3. Unraveling the Findings

  • At the emergency department evaluation, 72% of participants reported moderate to severe pain, with the most common sites being the chest, neck, upper back, lower back, and head.
  • Persistent pain at 6 months was reported by 26% of participants and was associated with acute pain severity, specific pain locations, poor self-rated health, and pre-motor vehicle crash depressive symptoms.
  • More than half of the participants continued to receive analgesics, and 10% became long-term opioid users.
  • Functional decline and disability were significant consequences, impacting activities of daily living and necessitating changes in living situations for those with persistent pain.

4. The Nuances of Persistent Pain in Older Adults

  • The study challenges preconceptions that persistent pain after a motor vehicle crash in older adults is solely a problem of persistent neck pain.
  • Chest pain, common in older adults at the emergency department, was infrequently reported at follow-up, indicating that some chest pain may result from acute injuries without persistent consequences.

5. Implications for Clinical Practice

  • Emergency physicians are urged to recognize that a substantial number of older patients with seemingly minor injuries are at risk for chronic pain.
  • The findings highlight the importance of addressing not only pain relief but also the prevention of persistent pain to mitigate functional decline and disability.
  • Even seemingly minor injuries in older adults can have lasting effects, necessitating a heightened awareness among healthcare professionals.

In conclusion, this study delves into the nuanced realm of persistent pain in older adults following motor vehicle crashes, emphasizing the need for proactive measures in geriatric care. By understanding the risk factors and consequences, healthcare providers can tailor interventions to alleviate pain and enhance the overall well-being of older adults navigating the complex aftermath of motor vehicle crashes.