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Don't Depend on Patients Health Report After Motor Vehicle Accidents

Patients with chronic neck or back pain from a motor-vehicle accident (MVA) seeking medical care often fill out paperwork asking for their health history. They may be asked about previous episodes of pain, history of depression, and psychologic problems. A drug and alcohol history is also included.

The information taken from the health history can be very valuable in guiding the treatment plan. For example, depression, drug abuse, alcoholism, and psychologic distress have all been linked with a poor prognosis for new episodes of musculoskeletal pain.

The risk of a future MVA with possible serious injury is also increased in patients with a history of drug or alcohol abuse. Usually, patient answers are assumed to be accurate and true.

But in this study, more than two-thirds of the patients denied a previous history of psychologic distress. They also denied alcohol or other drug abuse and previous neck or back pain. Looking back at their medical records, this information was incorrect. And 80 per cent of the patients who were involved with legal proceedings did not reveal a past history of musculoskeletal pain or other serious health problems.

It appears that patients who think the accident was someone else's fault were more likely to deny a positive social history for the use of alcohol and other drugs or mental health problems. The rates of these problems reported were much lower in patients after a MVA than when compared to others. The standard for comparison was people of similar ages and gender who had not had an accident.

The results of this study question the validity of neck and back pain patients' self-reported history after a car accident. Under-reporting pain and other problems is common in patients who have filed a compensation claim or retained a lawyer.

Treatment decisions based on self-reported responses must be made carefully. Failure to identify serious psychologic and substance abuse problems can have a major effect on public health such as cost and policies.

Health care professionals can use the period after a serious MVA to find out about alcohol and other drug problems. Patients may be more open to an intervention program. Patients can be educated about the risk of another MVA with more serious injuries.

References: Eugene J. Carragee, MD. Validity of Self-Reported History in Patients with Acute Back or Neck Pain After Motor Vehicle Accidents. In The Spine Journal. March/April 2008. Vol. 8. No. 2. Pp. 311-319.

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