AEM Early Access 17: Post-Traumatic Symptoms and Acute Pain Following Injury

Welcome to the seventeenth episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to an recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

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DISCUSSING: (OPEN ACCESS THROUGH JULY 31, 2018; CLICK ON TITLE TO ACCESS.)

The Association between Daily Posttraumatic Stress Symptoms and Pain over the First 14‐days after Injury: An Experience Sampling Study. Maria L. Pacella PhD,  Jeffrey M. Girard MS,  Aidan G.C. Wright PhD,  Brian Suffoletto MD, Clifton W. Callaway MD,PhD.

listen now: author interview with Dr. maria pacella

Maria Pacella, PhD

Research Assistant Professor

Department of Emergency Medicine

University of Pittsburgh

article abstract:

Objectives
Psychosocial factors and responses to injury modify the transition from acute to chronic pain. Specifically, posttraumatic stress disorder symptoms (PTSS; reexperiencing, avoidance, and hyperarousal symptoms) exacerbate and co‐occur with chronic pain. Yet no study has prospectively considered the associations among these psychological processes and pain reports using experience sampling methods (ESM) during the acute aftermath of injury.

This study applied ESM via daily text messaging to monitor and detect relationships among psychosocial factors and post‐injury pain across the first 14‐days after emergency department (ED) discharge.

Methods
We recruited 75 adults (59% male; M age = 33) who experienced a potentially traumatic injury (i.e., involving life threat or serious injury) in the past 24‐hours from the EDs of two Level 1 trauma centers. Participants received 5 questions per day via text messaging from Day‐1 to Day‐14 post‐ED discharge; three questions measured PTSS, one question measured perceived social support, and one question measured physical pain.

Results
Sixty‐seven participants provided sufficient data for inclusion in the final analyses, and the average response rate per subject was 86%. Pain severity score decreased from a mean of 7.2 to 4.4 over 14 days and 50% of the variance in daily pain scores was within‐person. In multilevel structural equation models, pain scores decreased over time, and daily fluctuations of hyperarousal (b = 0.22, 95% CI [0.08, 0.36]) were uniquely associated with daily fluctuations in reported pain level within each person.

Conclusions
Daily hyperarousal symptoms predict same‐day pain severity over the acute post‐injury recovery period. We also demonstrated feasibility to screen and identify patients at risk for pain chronicity in the acute aftermath of injury. Early interventions aimed at addressing hyperarousal (e.g. anxiolytics) could potentially aid in reducing experience of pain.

ADDITIONAL READING:

Bryant, R.A., et al., The psychiatric sequelae of traumatic injury. American Journal of Psychiatry, 2010.

Gatchel, R.J., et al., The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull, 2007. 133(4): p. 581-624.

Rosenbloom, B.N., et al., Predicting pain outcomes after traumatic musculoskeletal injury. Pain, 2016. 157(8): p. 1733-1743.

O'Donnell, M.L., et al., Disability after injury: the cumulative burden of physical and mental health. J Clin Psychiatry, 2013. 74(2): p. e137-43.

Feinberg, R.K., et al., Stress-related psychological symptoms contribute to axial pain persistence after motor vehicle collision: path analysis results from a prospective longitudinal study. Pain, 2017. 158(4): p.682-690.

Price, M., et al., A feasibility pilot study on the use of text messages to track PTSD symptoms after a traumatic injury. Gen Hosp Psychiatry, 2014. 36(3): p. 249-54.