Interactions between gender and other risk factors are associated with persistent neck pain after motor vehicle collision

Persistent moderate or severe neck pain (MSNP) after motor vehicle collision (MVC) is an international public health problem. Increasing evidence suggests that the etiology of persistent pain in women and men may differ, but to date gender differences in risk factors for post-MVC MSNP have not been assessed. In this prospective observational study, we evaluated for gender differences in risk factors for MSNP six weeks after MVC. European American men and women ≥18 and ≤ 65 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 fracture or other injury requiring hospital admission were enrolled. Baseline ED assessment included an evaluation of participant demographic, pre-MVC health, and initial symptom characteristics. Six week telephone follow-up assessment included evaluation for the presence of MSNP (defined as neck pain ≥4 on 0 - 10 NRS during the past week). Participants reporting involvement in litigation at six week follow-up were excluded. Interactions between gender and other predictors were evaluated and relative risks (RRs) by gender were estimated using Poisson regression adjusted for study site. Interactions with p < .10 were considered significant. 711/948 (75%) of enrolled patients completed 6 week follow-up and were non-litigants. The strength of association (RR) between a number of predictors and MSNP significantly differed between women and men, including severe pre-MVC depression (1.2 vs. 2.8), high catastrophizing (1.2 vs. 3.5), highest age tertile (1.3 vs. 3.3), rear end collision (1.1 vs. 2.3), and increased estimated time to physical recover at time of initial ED visit (1.5 vs. 3.0). These findings indicate that risk factors for MSNP 6 weeks after MVC differ between women and men. Further studies are needed to better understand gender differences in the etiology of post-traumatic pain. Supported by NIAMS R01AR056328.