Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
OBJECTIVES To describe the distribution of bodily pain and identify common patterns of pain localization after traffic injury. METHODS Cross-sectional analysis of a population-based cohort of 6481 Saskatchewan residents who were treated or filed an auto insurance claim within 30 days of traffic injury or both. The prevalence of pain in each of 13 body areas was calculated and compared with pain confined exclusively to each of these areas. Principal component analysis was used to identify the main patterns of pain localization after traffic injury. RESULTS Irrespective of pain in other areas, 86% of respondents reported posterior neck pain, 72% indicated head pain, and 60% noted lumbar back pain. Ninety-five percent of claimants reported some pain within the posterior trunk region, comprising the posterior neck, shoulder, mid-back, lumbar, and buttock areas. Only 0.4% of respondents reported posterior neck pain only. Four main patterns accounted for 60% of the variance in pain localization: 1) upper anterior trunk and upper extremity pain; 2) head, posterior neck, and upper posterior trunk pain; 3) low back pain; and 4) lower anterior trunk and lower extremity pain. CONCLUSION Pain after traffic injury is most commonly reported in multiple body areas; isolated neck pain is extremely rare. These results have implications for clinical management of traffic injuries and interpretation of whiplash-related trials.