Many older adults have persistent pain after car crashes

(Reuters Health) - One in four seniors who’ve been in car accidents will have lasting pain, and many will struggle to perform basic daily activities in the months afterward, a new study suggests.

Car crashes are the second most common form of trauma among older adults, the researchers write in Annals of Emergency Medicine.

Lead author Timothy Platts-Mills, of the University of North Carolina at Chapel Hill, said his team’s long-term goal is to prevent this type of trauma from developing into persistent pain for older adults.

“The purpose of this study was to determine the frequency of persistent pain and functional decline and identify patient characteristics associated with these outcomes,” Platts-Mills said in an email.

His team recruited 161 patients age 65 and older who went to the emergency room after a car crash but didn’t end up being hospitalized. Patients with fractures, major cuts, and brain or spine injuries were not included in the analysis.

The participants were interviewed in person at the hospital. They also completed follow-up assessments by mail or phone at six weeks, six months, and one year after the accident.

Pain was rated on a scale from 1 to 10, both overall and in 15 specific parts of the body. People reporting a pain level of 4 or higher after six months were considered to have persistent pain.

Participants also rated their ability to perform daily functions such as walk, climb stairs, and carry groceries.

In the initial emergency room interview, 72 percent of patients reported moderate to severe pain. After six months, 26 percent were still having moderate to severe pain from the car crash.

People with persistent pain were more likely to have had pain in the head, neck, jaw, lower back, or legs in the emergency room.

Compared to patients without pain, patients who did have chronic pain reported poor self-rated health and less formal education. They were also more likely to have symptoms of depression before the crash and to expect their recovery to take more than 30 days.

Participants with persistent pain also experienced much more “pain interference” with their physical functioning and daily living activities and were more likely to have changed their living situation to get extra help.

Roger Fillingim, a distinguished professor at the University of Florida College of Dentistry, noted that chronic pain is very common and affects 100 million people in the United States.

Fillingim, who studies the problem, said in an email that chronic pain is “arguably the most expensive and most prevalent health problem in the United States,” and that this is particularly true for older adults.

Persistent pain carries additional health and safety risks. Previous studies have shown that it increases risk of falls and may be associated with decreased cognitive performance in older people, Fillingim noted.

Platts-Mills said one way to combat persistent pain is to tackle it early. “More effective control of pain symptoms in the emergency department and in the early recovery period may reduce persistent pain,” he said.

For older people who have been in an accident, Platts-Mills recommends staying physically active to reduce long-term pain and decline in physical functioning.

Platts-Mills also noted that many of the study’s participants had not been re-evaluated by a physician after a few weeks, and that this may be part of the issue.

“If you or a family or friend is in a car crash, it is important to be re-evaluated if pain symptoms persist,” he advised.

SOURCE: Annals of Emergency Medicine, online June 16, 2015.