Publication Date
2014
Journal Title
Pain
Abstract
Living in a lower socioeconomic status neighborhood has been shown to alter stress system function and is associated with a number of adverse health outcomes, but its influence on musculoskeletal pain (MSP) outcomes after traumatic stress exposures such as motor vehicle collision (MVC) has not been assessed. We performed a multicenter, prospective study that enrolled 948 European-American individuals within 24 hours of MVC who were discharged home after emergency department evaluation. Follow-up evaluations were completed via telephone or Internet survey 6 weeks, 6 months, and 1 year after MVC on 91%, 89%, and 91% of participants, respectively. A robust aggregate measure of census tract neighborhood disadvantage was derived, and individual-level characteristics assessed included socioeconomic and demographic characteristics, pain prior to MVC, litigation status, and opioid use. MSP was assessed in the emergency department; MSP and pain interference with daily activity were assessed at 6 weeks, 6 months, and 1 year. After adjustment for individual-level factors, living in more disadvantaged neighborhoods was associated with increased MSP (P = 0.0009) and increased pain interference with daily function (P < 0.0001). The relationship between neighborhood disadvantage and MSP was moderated by a common single nucleotide polymorphism, rs2817038, 5' of the gene encoding FKBP5, a functional regulator of glucocorticoid receptor sensitivity (interaction P-value = 0.0015). These data support the hypothesis that low neighborhood socioeconomic status increases the likelihood of worse MSP outcomes after traumatic stress exposures such as MVC, and that this influence is mediated in part via its influence on stress system function. (C) 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Volume Number
155
Issue Number
10
Pages
2116-2123
Document Type
Article
EPub Date
2014/08/12
Status
Faculty
Facility
School of Medicine
Primary Department
Emergency Medicine
PMID
DOI
10.1016/j.pain.2014.07.025