Pain and quality of life 1 year after admission to the emergency department: factors associated with pain

Eur J Trauma Emerg Surg. 2013 Aug;39(4):353-61. doi: 10.1007/s00068-013-0271-9. Epub 2013 Mar 8.

Abstract

Objectives: This study describes the prevalence of pain in trauma patients 1 year after hospital admission and investigates separately health-related quality of life (QoL) for patients suffering severe pain and for those without pain. Moreover, psychosocial factors are examined for their impact on pain.

Methods: Patients were contacted 12 months after admission in order to complete the following questionnaires: Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Trauma Outcome Profile (TOP), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Impact of Event Scale-Revised (IES-R) and additional questions concerning satisfaction, work and financial status. Relevant pain at follow-up was defined as <80 points on the pain subscale of the TOP.

Results: Two hundred and twenty patients were included. The Injury Severity Score (ISS) ranged from 1 to 41. Fifty-three percent (53 %) of patients suffered a severe trauma (ISS > 15). One year after injury, 55 % of patients had relevant pain according to the TOP. Patients with pain were older (41.4 vs. 34.4 years, p = 0.003) and had slightly more severe injuries (ISS 17.1 vs. 14.9, p = 0.115). There were significant differences between pain and no-pain patients on all domains of QoL (p < 0.001) and on the BDI, STAI and IES-R (p < 0.001). Pain patients more often experienced a stressful event and job-related and financial difficulties. Multivariate logistic regression analysis revealed post-traumatic stress disorder (PTSD) as the strongest predictor for pain [odds ratio (OR): 4.38, p = 0.015], followed by a stressful life event (OR: 4.08, p = 0.001).

Discussion: Pain is strongly associated with psychosocial complaints 1 year after trauma. For the treatment of pain following a traumatic event, social reintegration and emotional regulation by means of occupational rehabilitation and psychotherapy should receive more attention.

Keywords: PTSD; Pain; Psychosocial; Quality of life; Trauma.