Biopsychosocial sequelae of chronically painful injuries sustained in motor vehicle accidents contributing to non-recovery: A retrospective cohort study

Background: Claimants with chronically painful injuries sustained in motor vehicle accidents (MVAs) undergo assessment and management influenced by insurance and medico-legal processes defined by a biomedical paradigm which is discordant with best evidence. We aim to demonstrate the impact of biopsychosocial factors on post-MVA sequelae which contribute to non-recovery. Methods: This was a retrospective cohort study of medico-legal documents and reports on 300 consec-utive claimants referred to a pain medicine physician over 7 years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. One hundred data items were extracted from the medico-legal doc-uments and reports for each claimant and entered into an electronic database. Post-MVA sequelae were analysed using chi-square analysis (OR > 2) for significant associations with demographic, pre-MVA and post-MVA variables. Factors with significant associations were entered into a logistic regression model to determine significant statistical predictors of post-MVA sequelae contributing to non-recovery. Results: The claimants were aged 17 to 80 years (mean age 42 years), and approximately half (53%, n = 159) were female. The time from MVA to interview averaged 2.5 years. Widespread pain was present in 18% (n = 54), and widespread somatosensory signs implying central sensitisation (OR = 9.85, p < .001) was the most significant multivariate association. Long-term opiate use post-MVA (32%) was predicted by pre-MVA sleep disturbance (OR = 5.08, p = .001), post-MVA major depressive disorder (MDD) (OR = 3.02, p = .003) and long-term unemployment (OR = 2.22. p = .007). Approximately half (47%, n = 142) required post-MVA support from a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was diag-nosed by a psychiatrist or psychologist in 20% (n = 59), yet early identification of risk of PTSD was rare. Pre-MVA, 89.4% (n = 268) were studying or employed. Permanent unemployability post-MVA occurred in 35% (n = 104) and was predicted by MDD (OR = 3.59, p = .001) and antidepressant use (OR = 2.17, p = .005). Major social change post-MVA (70%) was predicted by older age (OR = .966, p = .003), depressive symptoms (OR = 3.71, p < .001) and opiate use (OR = 2.00, p = .039).Conclusions: Biomedical factors, including older age, impaired sleep and indicators of widespread central sensitisation, and psychological factors, including stress, anxiety and depression, were the most promi-nent multivariate associations as statistical predictors of major adverse sequelae contributing to non -recovery for claimants with chronic pain post-MVA.(c) 2022 Elsevier Ltd. All rights reserved.