Initial neuropathic pain symptoms predict musculoskeletal pain severity six weeks after MVC

Neuropathic pain symptoms have been shown to predict persistent postoperative pain, however to date the ability of neuropathic pain symptoms to predict persistent musculoskeletal pain has not been assessed. In this prospective observational study, we assessed the ability of neuropathic pain symptoms to predict musculoskeletal pain severity six weeks after motor vehicle collision (MVC). European Americans ≥18 years of age presenting to one of eight emergency departments (EDs) in four no-fault insurance states within 24 hours of MVC who did not have a fracture or other injury requiring hospital admission were enrolled. Baseline interviews were performed at the time of ED evaluation and included an assessment of overall pain severity (0-10 scale). Neuropathic pain symptoms (DN4 questionnaire) were assessed in individuals reporting pain (ED pain score ≥1). Six week telephone follow-up evaluation included an assessment of overall pain and neck pain intensity during the past week (each assessed using a 0-10 scale). In the ED, 109/115 (95%) patients reported acute pain (score ≥1); 76/109 (70%) of these patients reported experiencing one or more neuropathic pain symptoms. Number of neuropathic pain symptoms and ED pain severity were moderately correlated (r=0.35, p=0.01). 78/115 (68%) patients reported persistent MVC-related pain (score ≥1) six weeks after MVC; 61/78 (78%) of these individuals reported coincident neuropathic pain symptoms. In a model adjusting for patient age and sex, the number of neuropathic pain symptoms reported in the ED predicted overall pain intensity at 6 weeks (β=0.49, p<0.01). The individual ED neuropathic pain symptom that most strongly predicted 6 week pain severity was painful cold (β=2.31, p<0.05). These results suggest that neuropathic pain symptoms are common in the immediate aftermath of MVC and predict pain severity at six weeks. Supported NIAMS R01AR056328 and NIH T35 Grant 5T35DK007386-32. Neuropathic pain symptoms have been shown to predict persistent postoperative pain, however to date the ability of neuropathic pain symptoms to predict persistent musculoskeletal pain has not been assessed. In this prospective observational study, we assessed the ability of neuropathic pain symptoms to predict musculoskeletal pain severity six weeks after motor vehicle collision (MVC). European Americans ≥18 years of age presenting to one of eight emergency departments (EDs) in four no-fault insurance states within 24 hours of MVC who did not have a fracture or other injury requiring hospital admission were enrolled. Baseline interviews were performed at the time of ED evaluation and included an assessment of overall pain severity (0-10 scale). Neuropathic pain symptoms (DN4 questionnaire) were assessed in individuals reporting pain (ED pain score ≥1). Six week telephone follow-up evaluation included an assessment of overall pain and neck pain intensity during the past week (each assessed using a 0-10 scale). In the ED, 109/115 (95%) patients reported acute pain (score ≥1); 76/109 (70%) of these patients reported experiencing one or more neuropathic pain symptoms. Number of neuropathic pain symptoms and ED pain severity were moderately correlated (r=0.35, p=0.01). 78/115 (68%) patients reported persistent MVC-related pain (score ≥1) six weeks after MVC; 61/78 (78%) of these individuals reported coincident neuropathic pain symptoms. In a model adjusting for patient age and sex, the number of neuropathic pain symptoms reported in the ED predicted overall pain intensity at 6 weeks (β=0.49, p<0.01). The individual ED neuropathic pain symptom that most strongly predicted 6 week pain severity was painful cold (β=2.31, p<0.05). These results suggest that neuropathic pain symptoms are common in the immediate aftermath of MVC and predict pain severity at six weeks. Supported NIAMS R01AR056328 and NIH T35 Grant 5T35DK007386-32.