Peixoto Cayden, Hyland Lindsay, Buchanan Derrick Matthew, Langille Erika, Nahas Richard
The Seekers Centre, Ottawa, ON, Canada,
Department of Neuroscience, Carleton University, Ottawa, ON, Canada.
J Pain Res. 2018 Sep 20;11:1927-1936. doi: 10.2147/JPR.S165077. eCollection 2018.
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).
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.
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.
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.
创伤综合临床三联征（PCT）是一种复杂的病症，由慢性疼痛、创伤后应激障碍（PTSD）和脑震荡后综合征（PCS）三种共病诊断组成。PCT在从部署任务返回的退伍军人中已有记录，但这是关于机动车碰撞（MVC）后非军事人员中PCT患病率的首次报告。
数据来自71名转至社区诊所进行慢性疼痛管理的患者的常规入院评估。所有患者在标准化入院评估期间完成了《精神疾病诊断与统计手册》第五版创伤后应激障碍检查表（PCL - 5）和Rivermead脑震荡后症状问卷（RPQ）。还得出了一个额外的改良RPQ分数，以解决先前报告的PCS与慢性疼痛之间的症状重叠问题。
在我们的样本中，标准和改良RPQ分数得出的PCS患病率分别为100%和54.9%。结果表明，仅限于视觉和前庭症状的改良RPQ分数可能是慢性疼痛患者中更有用的PCS筛查标准。85.9%的患者符合PCL - 5上的PTSD筛查标准。MVC后因慢性疼痛转诊的患者中，超过一半符合PCT标准（52.1%）。符合PCT标准的患者报告头痛、总体疼痛和睡眠质量结果更差。
在我们样本中MVC后患有慢性疼痛的患者中，超过一半符合PCT标准。可能需要一种仅限于视觉和前庭症状的改良RPQ评分方法来筛查这些患者中的PCS。
