AT A MEETING SPONSORED BY THE NATIONAL INSTITUTES OF HEALTH’S PAIN CONSORTIUM

BETHESDA, MD. (FRONTLINE MEDICAL NEWS)Senior citizens who have a motor vehicle collision are advised to maintain a regimen of physical activity in the weeks immediately following the crash; otherwise they risk developing persistent, severe pain later, a study showed.

“We’re interested in patients who didn’t require hospitalization and didn’t have severe injuries, which, as it turns out, is about 80% of older adults experiencing car accidents,” Dr. Timothy F. Platts-Mills of the department of emergency medicine at the University of North Carolina at Chapel Hill explained in an interview. Findings from previous studies have also suggested that leading a sedentary lifestyle can cause persistent pain, he added.

The study enrolled 156 adults aged 65 years of age or older who had emergency department visits less than 24 hours after being in a car crash. Each subject was given a Pain Activity Scale for the Elderly (PASE) survey to assess the level of physical activity they undertook at baseline and at 6 weeks after the accident. Subjects were then divided into two cohorts: individuals whose activity level dropped by 50% or more, and those who kept up their regular movement patterns.

In addition, patients were asked to assess their pain severity at baseline on a scale of 1-10; a score of 1-3 indicated mild pain, 4-6 indicated moderate pain, and 7-10 indicated severe pain. Subjects in both cohorts were then reevaluated at 6 months to determine whether pain persisted, and the intensity of pain that subjects experienced. Subjects were also asked to assess the level of difficulty they had when performing six Activities of Daily Living (ADL) exercises.

Of the subjects, 83% reported no difficulty performing ADLs prior to their car accident, but 60% had difficulty at 6 months. The average pain score was 5.4 when assessed after the accident in the emergency department, but dropped to 3.6 at 6-week follow-up; at baseline, 33% reported moderate pain and 41% reported severe pain. However, at 6 months, the mean pain score was significantly higher in subjects whose physical activity decreased by at least 50%, compared with those who maintained higher rates of activity: 4.2 vs. 2.2, respectively.

Of the subjects, 31% reported that their physical activity decreased by more than 50%. Of those, 37% reported experiencing depression, compared with 18% of those who did not decrease activity. Of those who became less active, 81% reported pain scores of 4 or higher, indicating “moderate to severe” pain, versus 68% in the cohort who maintained the same level of activity. Axial pain was higher in those who became less active (67% vs. 56%), but lower-extremity pain was slightly higher in the cohort who remained after the accidents as they had been before (32% vs. 28%).

“We then did an analysis where we adjusted for all of the characteristics that we saw in the emergency departments [since] people who decreased their activity might have also had more pain, or maybe a worse injury,” said Dr. Platts-Mills. “We controlled for characteristics of the patients – sociodemographic characteristics, pain severity, location of pain – and even after adjusting for all of those characteristics, we still saw [that] people who decreased their physical activity had higher rates of persistent pain.”

From this analysis, Dr. Platts-Mills and his coinvestigators were able to determine that subjects who were older (greater than 75 years of age), female, depressed, and experiencing axial pain were more likely to decrease their physical activity by at least 50%, thereby experiencing more persistent pain. Depression, pain in the emergency department, axial pain, and lower-extremity pain were all consistently higher in the decreased-activity cohort after adjustment.

“To me, what that suggests is that there may be a causal relationship there, so decreasing physical activity might actually be causing persistent pain, and that’s been suggested by some other works,” said Dr. Platts-Mills. “So the inference [is] that if we can promote physical activity in the early recovery period for older adults after an injury … then we may improve outcomes.”

This study was supported by an award from the National Institute on Aging. Dr. Platts-Mills did not report any other relevant financial disclosures.

dchitnis@frontlinemedcom.com

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