Frequency of relevant back pain two years after trauma and the effect on health-related quality of life

Abstract

BACKGROUND:

Persisting back pain is a frequent consequence after severe trauma including injury to the spine. Reports on the incidence and relevance of back pain in severely injured patients in the absence of direct injury to the spine are scarce.

OBJECTIVE:

To assess the frequency of relevant back pain and its effect on health-related quality of life (HRQoL) in trauma patients with spine injury compared to patients without direct impact to spine postdischarge and two years after trauma within an observational study.

METHODS:

A two-year follow-up survey by using the Polytrauma Outcome Chart (PoloChart) and a set of specific questionnaires on socioeconomic and other HRQoL aspects was conducted among adult patients that had been treated for severe traumatic injuries (ISS $⩾$ 9) at a German level 1 trauma center between 2008 and 2017. Patient subgroups included patients with relevant (VAS $⩾$ 3) versus non-relevant back pain (VAS $<$ 3) stratified by visual analogue scale (VAS 0–10). Patients with relevant back pain were separated into patients with (AIS spine $⩾$ 1) and without spine injury (AIS spine $=$ 0) according to the Abbreviated Injury Score (AIS).

RESULTS:

543/1010 questionnaires were returned yielding a response rate of 54%. Patients were predominantly male ( $n=$ 383/543; 71%) with a mean age 45 $\pm$ 19 years, mostly blunt trauma ( $n=$ 524/543; 97%) and a mean ISS 18 $\pm$ 12 points. 32.4% of patients had sustained a spine injury defined by an AIS spine $⩾$ 1 ( $n=$ 176/543). Half of these patients suffered from relevant back pain two years after trauma ( $n=$ 90/176; 51.1%); in contrast, in non-spine injured patients one in three patients reported relevant back pain ( $n=$ 127/367; 34.6%). Patients with relevant back pain reported significantly lower HRQoL as measured by the 36-Item Short Form Health Survey and the Trauma Outcome Profile. The use of pain medication after discharge and at two years after trauma was significantly higher in patients with relevant back pain ( $n=$ 183/211; 86.7% vs. $n=$ 214/318; 75.8%; $p<$ 0.001; pain medication 2 years after trauma: $n=$ 113/210, 53.8% vs. 68/317, 21.5%, $p<$ 0.001).

CONCLUSION:

Persisting back pain is frequent at two years after trauma independent of presence or absence of initial injury to the spine and associated with lower HRQoL in almost every dimension including physical, mental and social domains.