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The polytrauma clinical triad in patients with chronic pain after motor vehicle collision

Authors Peixoto C, Hyland L, Buchanan DM, Langille E, Nahas R

Received 9 February 2018

Accepted for publication 24 June 2018

Published 20 September 2018 Volume 2018:11 Pages 1927—1936


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr E Alfonso Romero-Sandoval

Cayden Peixoto,1 Lindsay Hyland,2 Derrick Matthew Buchanan,2 Erika Langille,2 Richard Nahas3

1The Seekers Centre, Ottawa, ON, Canada; 2Department of Neuroscience, Carleton University, Ottawa, ON, Canada; 3Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada

Background: The polytrauma clinical triad (PCT) is a complex disorder composed of three comorbid diagnoses of chronic pain, post-traumatic stress disorder (PTSD), and postconcussion syndrome (PCS). PCT has been documented in veterans returning from deployment, but this is the first report on PCT prevalence in nonmilitary personnel after a motor vehicle collision (MVC).
Methods: Data were drawn from routine intake assessments completed by 71 patients referred to a community-based clinic for chronic pain management. All patients completed the post-traumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PCL-5), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ) during a standardized intake assessment. An additional modified RPQ score was derived to address previously reported symptom overlap between PCS and chronic pain.
Results: Standard and modified RPQ scores yielded PCS prevalence rates of 100% and 54.9% in our sample, respectively. Results suggest that a modified RPQ score, limited to visual and vestibular symptoms, may be more useful PCS screening criteria in patients with chronic pain. PTSD screening criteria on the PCL-5 were met by 85.9% of the patients. More than half of the patients referred for chronic pain after MVC met criteria for PCT (52.1%). Patients who met PCT criteria reported worse headache, overall pain, and sleep quality outcomes.
Conclusion: Among patients in our sample with chronic pain after MVC, more than half met criteria for PCT. A modified approach to RPQ scoring limited to visual and vestibular symptoms may be required to screen for PCS in these patients.

Keywords: chronic pain, mTBI, concussion, PTSD, MVC

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