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. 2014 Feb;155(2):309-321.
doi: 10.1016/j.pain.2013.10.016. Epub 2013 Oct 18.

Incidence and predictors of neck and widespread pain after motor vehicle collision among US litigants and nonlitigants

Samuel A McLean  1 , Jacob C Ulirsch, Gary D Slade, April C Soward, Robert A Swor, David A Peak, Jeffrey S Jones, Niels K Rathlev, David C Lee, Robert M Domeier, Phyllis L Hendry, Andrey V Bortsov, Eric Bair
Affiliations

Incidence and predictors of neck and widespread pain after motor vehicle collision among US litigants and nonlitigants

Samuel A McLean et al. Pain. 2014 Feb.

Abstract

Debate continues regarding the influence of litigation on pain outcomes after motor vehicle collision (MVC). In this study we enrolled European Americans presenting to the emergency department (ED) in the hours after MVC (n=948). Six weeks later, participants were interviewed regarding pain symptoms and asked about their participation in MVC-related litigation. The incidence and predictors of neck pain and widespread pain 6weeks after MVC were compared among those engaged in litigation (litigants) and those not engaged in litigation (nonlitigants). Among the 859 of 948 (91%) participants completing 6-week follow-up, 711 of 849 (83%) were nonlitigants. Compared to nonlitigants, litigants were less educated and had more severe neck pain and overall pain, and a greater extent of pain at the time of ED evaluation. Among individuals not engaged in litigation, persistent pain 6weeks after MVC was common: 199 of 711 (28%) had moderate or severe neck pain, 92 of 711 (13%) had widespread pain, and 29 of 711 (4%) had fibromyalgia-like symptoms. Incidence of all 3 outcomes was significantly higher among litigants. Initial pain severity in the ED predicted pain outcomes among both litigants and nonlitigants. Markers of socioeconomic disadvantage predicted worse pain outcomes in litigants but not nonlitigants, and individual pain and psychological symptoms were less predictive of pain outcomes among those engaged in litigation. These data demonstrate that persistent pain after MVC is common among those not engaged in litigation, and provide evidence for bidirectional influences between pain outcomes and litigation after MVC.

Keywords: Jurisprudence; Legislation; Motor vehicle collision; Musculoskeletal pain; Neck pain; Whiplash injuries.

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Conflict of interest statement

Conflict of interest statement: Gary Slade, PhD, is a consultant at Algynomics, Inc. No other authors reported potential conflicts of interest.

Figures

Figure 1
Figure 1
A flow chart of the cohort reported on in this study. At the top, potential participants screened at participing EDs and the reasons for exclusions. The number eligible is reported next, and reasons for refusal to participate in the study are listed. Enrolled participants, participants retained at six weeks, and participants involved in litigation are shown at the bottom.
Figure 2
Figure 2
Percentage of study participants with moderate or severe musculoskeletal pain (NRS ≥ 4) according to body region six weeks after motor vehicle collision (study participants not engaged in litigation only).
Figure 3
Figure 3
Associations between baseline characteristics (evaluated in the emergency department in the hours after motor vehicle collision) and moderate or severe neck pain at six weeks among individuals not seeking compensation ("non-litigants”, n = 859) and individuals seeking compensation ("litigants", n = 148) after motor vehicle collision. Characteristics investigated include (A) sociodemographic and crash characteristics (B) pain and somatic symptoms reported prior to and in the immediate aftermath of MVC and (C) psychological and cognitive characteristics. *Category listed second is reference group
Figure 3
Figure 3
Associations between baseline characteristics (evaluated in the emergency department in the hours after motor vehicle collision) and moderate or severe neck pain at six weeks among individuals not seeking compensation ("non-litigants”, n = 859) and individuals seeking compensation ("litigants", n = 148) after motor vehicle collision. Characteristics investigated include (A) sociodemographic and crash characteristics (B) pain and somatic symptoms reported prior to and in the immediate aftermath of MVC and (C) psychological and cognitive characteristics. *Category listed second is reference group
Figure 3
Figure 3
Associations between baseline characteristics (evaluated in the emergency department in the hours after motor vehicle collision) and moderate or severe neck pain at six weeks among individuals not seeking compensation ("non-litigants”, n = 859) and individuals seeking compensation ("litigants", n = 148) after motor vehicle collision. Characteristics investigated include (A) sociodemographic and crash characteristics (B) pain and somatic symptoms reported prior to and in the immediate aftermath of MVC and (C) psychological and cognitive characteristics. *Category listed second is reference group
Figure 4
Figure 4
Associations between baseline characteristics (evaluated in the emergency department in the hours after motor vehicle collision) and widespread pain at six weeks among individuals not seeking compensation ("non-litigants”, n = 859) and individuals seeking compensation ("litigants", n = 148) after motor vehicle collision. Characteristics investigated include (A) sociodemographic and crash characteristics (B) pain and somatic symptoms reported prior to and in the immediate aftermath of MVC and (C) psychological and cognitive characteristics. *Category listed second is reference group
Figure 4
Figure 4
Associations between baseline characteristics (evaluated in the emergency department in the hours after motor vehicle collision) and widespread pain at six weeks among individuals not seeking compensation ("non-litigants”, n = 859) and individuals seeking compensation ("litigants", n = 148) after motor vehicle collision. Characteristics investigated include (A) sociodemographic and crash characteristics (B) pain and somatic symptoms reported prior to and in the immediate aftermath of MVC and (C) psychological and cognitive characteristics. *Category listed second is reference group
Figure 4
Figure 4
Associations between baseline characteristics (evaluated in the emergency department in the hours after motor vehicle collision) and widespread pain at six weeks among individuals not seeking compensation ("non-litigants”, n = 859) and individuals seeking compensation ("litigants", n = 148) after motor vehicle collision. Characteristics investigated include (A) sociodemographic and crash characteristics (B) pain and somatic symptoms reported prior to and in the immediate aftermath of MVC and (C) psychological and cognitive characteristics. *Category listed second is reference group
Figure 5
Figure 5
Multivariate Predictive Models of MSNP and WP six weeks after MVC
Figure 5
Figure 5
Multivariate Predictive Models of MSNP and WP six weeks after MVC
Figure 5
Figure 5
Multivariate Predictive Models of MSNP and WP six weeks after MVC
Figure 5
Figure 5
Multivariate Predictive Models of MSNP and WP six weeks after MVC
Figure 6
Figure 6
Percent of individuals reporting engagement in litigation six weeks after motor vehicle collision according to overall pain severity in the ED (no pain (0 on NRS), mild pain (1–3.5 on NRS), moderate pain (4–6.5 on NRS), or severe pain (7–10 on NRS)) and health insurance status (Panel A) and income (Panel B). Results adjusted for age, sex, and state where participant recruited. *Comparisons designed with an asterix are significant at p < 0.05.
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