Population-based studies have suggested that up to 13% of adults suffer from chronic widespread pain, characterized by pain on both sides of the body, both above and below the waist. Such pain results in substantial disability and a reduced quality of life [1]. While the pathogenic underpinnings of chronic widespread pain remain poorly understood, motor vehicle accidents can trigger chronic widespread pain development in vulnerable individuals. Indeed, many studies have shed light on a link between motor vehicle accidents and the onset of chronic widespread pain [2]. Its etiology and treatment remain dynamic fields of investigation.
Certain studies have sought to dissect the relationship between physically traumatic events and the onset of chronic widespread pain. Data lent support to the “at risk” phenotype hypothesis, whereby individuals with a poorer health and predisposing factors may be vulnerable to developing chronic widespread pain following trauma from road traffic accidents.
Additional research sought to assess the influence of depression, pain intensity, whiplash-associated symptoms, and number of painful body areas on the progression of an individual’s pain. Subjects who experienced early depressive symptoms and more severe neck injury-associated pain were found to be at a heightened risk of developing widespread pain following a motor vehicle accident [2].
Independent research further found that pre-collision health-seeking behaviors, pre-collision somatization, and post-collision initial injury severity, in addition to an older age, were all independent predictive factors of the onset of widespread pain [3].
The patterns of pain progression – including whether pain begins as regional and then spreads, or begins as widespread, without remitting – remain an area of active study [4]. One study sought to specifically probe the trajectory of chronic widespread pain development (as assessed according to American College of Rheumatology criteria) among individuals who had presented to the emergency department for care shortly after a motor vehicle accident. Pain extent was assessed in the emergency department and 6 weeks, 6 months, and 1 year after the motor vehicle collision. While the number of painful body regions in the non-chronic widespread pain group declined, the number of painful body regions in the chronic widespread pain trajectory group remained relatively constant. Overall, these data suggested that chronic widespread pain begins as widespread pain in the early aftermath of a motor vehicle accident, without remitting. However, these findings and the details thereof remain to be confirmed.
Accurately identifying the trajectory of chronic widespread pain development following a vehicle accident will be key to understanding its etiological underpinnings and informing the design of additional studies. Future research is also warranted in order to examine what it is about an accident, or about one’s reaction to it, that results in an increased risk of developing chronic widespread pain. Such work will buoy the recovery of a large population of individuals suffering from chronic widespread pain.
Overall, chronic widespread pain after a motor vehicle accident is not an uncommon phenomenon, thereby requiring further research in order to best predict and treat it.
References
1. Macfarlane, G. J., McBeth, J. & Silman, A. J. Widespread body pain and mortality: Prospective population based study. Br. Med. J. (2001). doi: 10.1136/bmj.323.7314.662
2. Holm, L. W., Carroll, L. J., Cassidy, J. D., Skillgate, E. & Ahlbom, A. Widespread pain following whiplash-associated disorders: Incidence, course, and risk factors. J. Rheumatol. (2007).
3. Wynne-Jones, G., Jones, G. T., Wiles, N. J., Silman, A. J. & Macfarlane, G. J. Predicting new onset of widespread pain following a motor vehicle collision. J. Rheumatol. (2006).
4. Hu, J. M. et al. Chronic Widespread Pain after Motor Vehicle Collision Typically Occurs via Immediate Development and Non-Recovery: Results of an Emergency Department-Based Cohort Study. Pain 157, 438 (2016). doi: 10.1097/j.pain.0000000000000388.