Risk factors for persistent pain after motor vehicle collision differ between litigants and non-litigants

Worse pain outcomes are observed among individuals seeking monetary compensation after motor vehicle collision (MVC), but whether the etiology of persistent pain among such litigants differs from non-litigants remains poorly understood. One commonly used method for gaining insights into etiology is to evaluate risk factors for disease development. In this prospective observational study, we compared predictors of persistent pain after MVC among litigants and non-litigants. European Americans ≥18 years of age presenting to the emergency department (ED) within 24 hours of MVC who did not have a fracture or injury requiring hospital admission were enrolled. Baseline ED assessment included an evaluation of participant sociodemographic characteristics, pre-MVC health characteristics, MVC history, and participant cognitions and symptoms in the ED. Six week telephone follow-up evaluation assessed litigation status and neck pain intensity during the past week (0-10 NRS), scores ≥4 were defined as moderate/severe neck pain (MSNP). Candidate predictors of six week MSNP were assessed via logistic regression; significance levels were determined using Bonferroni correction (p=0.00125). Six week follow up was obtained in 849/948 (90%) of enrolled participants, and 148/849 (17%) reported that they had hired a lawyer to sue for compensation ("litigants"). MSNP was reported by 95/148 (64%) of litigants and 199/711 (28%) of non-litigants six weeks after MVC. Female sex, increased ED pain severity, and increased ED somatic symptom burden predicted 6 week MSNP among both litigants and non-litigants. Among litigants, unique predictors of 6 week MSNP included not working full time, not having health insurance, and being a vehicle passenger vs. driver. Among non-litigants, unique predictors of 6 week MSNP included believing that the MVC was someone else's fault and increased participant estimate of time to recovery (assessed at ED evaluation). These findings suggest that the etiology of persistent pain in litigants and non-litigants may differ. Supported NIAMS R01AR056328. Worse pain outcomes are observed among individuals seeking monetary compensation after motor vehicle collision (MVC), but whether the etiology of persistent pain among such litigants differs from non-litigants remains poorly understood. One commonly used method for gaining insights into etiology is to evaluate risk factors for disease development. In this prospective observational study, we compared predictors of persistent pain after MVC among litigants and non-litigants. European Americans ≥18 years of age presenting to the emergency department (ED) within 24 hours of MVC who did not have a fracture or injury requiring hospital admission were enrolled. Baseline ED assessment included an evaluation of participant sociodemographic characteristics, pre-MVC health characteristics, MVC history, and participant cognitions and symptoms in the ED. Six week telephone follow-up evaluation assessed litigation status and neck pain intensity during the past week (0-10 NRS), scores ≥4 were defined as moderate/severe neck pain (MSNP). Candidate predictors of six week MSNP were assessed via logistic regression; significance levels were determined using Bonferroni correction (p=0.00125). Six week follow up was obtained in 849/948 (90%) of enrolled participants, and 148/849 (17%) reported that they had hired a lawyer to sue for compensation ("litigants"). MSNP was reported by 95/148 (64%) of litigants and 199/711 (28%) of non-litigants six weeks after MVC. Female sex, increased ED pain severity, and increased ED somatic symptom burden predicted 6 week MSNP among both litigants and non-litigants. Among litigants, unique predictors of 6 week MSNP included not working full time, not having health insurance, and being a vehicle passenger vs. driver. Among non-litigants, unique predictors of 6 week MSNP included believing that the MVC was someone else's fault and increased participant estimate of time to recovery (assessed at ED evaluation). These findings suggest that the etiology of persistent pain in litigants and non-litigants may differ. Supported NIAMS R01AR056328.