Each year in the US, nearly 700,000 women are sexually assaulted. Chronic musculoskeletal pain (MSP) is commonly reported by women sexual assault (SA) survivors and associated with substantial suffering and poor health outcomes in cross-sectional studies. However, to date, no large, prospective, multisite studies evaluating the incidence and etiology of MSP after SA have been performed. The goal of the ongoing Women’s Health Study (WHS) is to successfully perform such a study. Women SA survivors, presenting for emergency care to a research network comprised of some of the largest SA care centers in the US, are approached for consent to perform a pain assessment, collect blood samples, access medical records related to the assault, and to be contacted in 48-72 hours to receive information regarding the full study. Individuals contacted who express interest in study participation undergo consent and in-person interview assessment at 1 week, followed by assessments at 6 weeks, 6 months, and 1 year. These evaluations will include an assessment of health services utilization, experiences with the legal system, and pain, psychological, and general health outcomes. A subset of consenting participants also receive more granular assessments via smartphone-based app. In addition, at each assessment, study participants also receive complete an evaluation of their experience with research participation. A full description of study design will be presented at the conference, along with data collected to- date regarding participant experiences with the research study, pain outcomes at the time of ED assessment, attrition into the full study as a function of ED pain characteristics, and 1 week pain outcomes. The WHS is funded by a consortium, including NIAMS, NICHD, NINDS, NINR, NIMH, and the NIH Office of the Director (R01AR064700-01A1).

Evidence suggests that body mass index (BMI) may influence the risk of an individual transitioning from acute to chronic musculoskeletal pain. In this study we evaluated the influence of BMI on risk of developing persistent moderate or severe musculoskeletal neck pain (MSMNP) 6 months after a motor vehicle collision (MVC). European Americans age ≥18 and <65 years presenting to the emergency department (ED) within 24 hours of MVC and discharged to home after ED evaluation were enrolled. Participant's height and weight data, collected via ED interview, were used to calculate BMI. BMI categories (underweight, normal, overweight, and obese) were defined using standard CDC cut-offs. Neck pain (0-10 NRS) was assessed in the ED via in-person interview and at 6 month follow-up via telephone interview or web-based questionnaire. NRS score ≥4 was defined as MSMNP. Participants reporting pain at 6 month follow-up were asked if the pain was MVC-related and only MVC-related pain was included in the data analyses. Height and weight data was available for 934/948 (99%) of enrolled ED patients, and 840/948 (89%) completed 6 month follow-up evaluation. While BMI was not associated with acute neck pain severity (F=0.389 p=0.76), baseline BMI category predicted persistent MSMNP 6 months after MVC (4/16 (25%)) underweight [RR vs. normal weight 1.4 [95%CI 0.6-3.4], 52/293 (18%) normal weight, 47/252 (19%) overweight (RR 1.1, 95%CI [0.7-1.5]), and 69/250 (28%) obese individuals (RR 1.6, 95%CI [1.1-2.3]), (χ2=9.3, p=0.025). These results remained essentially unchanged after adjusting for age and sex. In addition, obese individuals reported a greater number of body regions with persistent MVC-related pain at 6 months (2.01 vs. 2.55, F=4.25, p=0.04). BMI category alone was a poor predictor of persistent MSMNP presence vs. absence (AUROCC=0.565), indicating that weight status is a significant but non-deterministic predictor of MSMNP outcome. Supported by NIAMS R01AR056328.

Over four million adults present to US emergency departments (EDs) each year after motor vehicle collision (MVC); the great majority of these individuals are discharged to home after ED evaluation. A subset of these individuals develops chronic MVC-related widespread pain (CMWP). Typical trajectories by which individuals develop this morbid outcome (e.g. progressive extension of pain vs. early development with non-recovery) are unknown. We evaluated trajectories of pain extent in a large cohort of adult European Americans who presented to the ED within 24 hours of MVC. Study participants were interviewed in the ED at the time of initial presentation and six weeks, six months, and one year following MVC. Evaluation at each time point included an assessment of pain (0-10 NRS) in nineteen body regions. If pain in a body region was reported, the MVC-relatedness of the pain was assessed. Widespread pain (WP) was defined as MVC-related pain in ≥7 body regions. One year after MVC, 75/948 (9%) of enrolled participants had CMWP. Among this group, almost half (45.3%) had WP in the ED. WP at 6 weeks and 6 months were present in 67.6% and 54.9% of these participants, respectively. Trajectory analyses of extent of pain across time (performed via SAS PROC TRAJ) for the entire cohort (n=948) identified 8.7% of participants with pain distributions over time consistent with a trajectory of initial WP in the ED and non-recovery across time. Together these data support the hypothesis that most individuals developing CMWP after MVC develop early WP that does not remit and suggest that individuals developing CMWP after MVC could be identified in the early post-MVC period and targeted for early preventive interventions. Supported by NIAMS R01AR056328. Over four million adults present to US emergency departments (EDs) each year after motor vehicle collision (MVC); the great majority of these individuals are discharged to home after ED evaluation. A subset of these individuals develops chronic MVC-related widespread pain (CMWP). Typical trajectories by which individuals develop this morbid outcome (e.g. progressive extension of pain vs. early development with non-recovery) are unknown. We evaluated trajectories of pain extent in a large cohort of adult European Americans who presented to the ED within 24 hours of MVC. Study participants were interviewed in the ED at the time of initial presentation and six weeks, six months, and one year following MVC. Evaluation at each time point included an assessment of pain (0-10 NRS) in nineteen body regions. If pain in a body region was reported, the MVC-relatedness of the pain was assessed. Widespread pain (WP) was defined as MVC-related pain in ≥7 body regions. One year after MVC, 75/948 (9%) of enrolled participants had CMWP. Among this group, almost half (45.3%) had WP in the ED. WP at 6 weeks and 6 months were present in 67.6% and 54.9% of these participants, respectively. Trajectory analyses of extent of pain across time (performed via SAS PROC TRAJ) for the entire cohort (n=948) identified 8.7% of participants with pain distributions over time consistent with a trajectory of initial WP in the ED and non-recovery across time. Together these data support the hypothesis that most individuals developing CMWP after MVC develop early WP that does not remit and suggest that individuals developing CMWP after MVC could be identified in the early post-MVC period and targeted for early preventive interventions. Supported by NIAMS R01AR056328.

Negative expectations have been found to be powerful predictors of adverse pain outcomes. Individual characteristics associated with negative recovery expectations may provide useful clues regarding the potential etiology of such expectations; however, to date, no studies have evaluated the association between individual characteristics and recovery expectations after motor vehicle collision (MVC). In this study, we evaluated characteristics associated with negative recovery expectations in a large cohort of European Americans ≥18 and < 65 years of age who presented to the emergency department (ED) within 24 hours of MVC. Exclusion criteria included hospital admission after ED evaluation. Enrolled patients completed an ED interview which assessed recovery expectations: certainty of recovery, estimated time to physical recovery (ETPR) and estimated time to emotional recovery (ETER). Consistent with previous studies, individuals uncertain of recovery (UOR, 267/948, 28%), those with longer ETPR (>2 weeks, 263/948, 30%), and those with longer ETER (>4 weeks, 341/948, 45%) had substantially worse outcomes (e.g., each recovery expectation predicted moderate/severe neck pain and posttraumatic stress disorder at 6 months at p < 0.0001 level). Bivariate analyses assessed the relationship of each recovery expectation with sociodemographic factors, pre-MVC physical and mental health factors, MVC characteristics, and post-MVC psychological and somatic symptoms. A number of factors across each of these domains were associated with each expectation, with the exception of MVC-related characteristics, which were generally poorly associated with recovery expectations. Backwards stepwise logistic regression modeling (pin=0.10, pout=0.15) using factors associated at p<0.05 in bivariate analyses yielded sets of characteristics associated with certainty of recovery, ETPR, and ETER. Each of these models contained multiple potential modifiable risk factors. Results of bivariate and multivariate analyses will be presented at the conference. Supported by NIAMS R01AR056328.

Millions of Americans present to the emergency department (ED) each year after motor vehicle collision (MVC); more than 90% are discharged to home after ED evaluation. Acute musculoskeletal pain (MSP) is the norm in these individuals, and 20-40% transition to chronic MSP, most commonly in the axial region (neck/shoulders, back). ED-based risk stratification tools have been developed for a variety of clinical conditions and are a necessary for the development and testing of ED-based preventive interventions for high risk individuals. No ED-based risk stratification tools are currently available for chronic post-MVC axial MSP (CPAM). We developed a risk stratification tool for CPAM, using data from a prospective multisite longitudinal study of individuals evaluated 6 weeks, 6 months, and 1 year after MVC (n=860). CPAM, defined by the presence of MVC-related MSP ≥4 (on 0-10 NRS) in one or more axial body regions 6 weeks and 6 and/or 12 months after MVC, was present in 303/860 (35%). Bivariate analyses identified 26 candidate predictor variables; logistic regression with backward selection was then applied to these candidate predictors in 1000 bootstrap samples. The top five predictors selected in >90% of bootstrap samples and retained in the final prediction model were: patient age, severity of neck pain in the ED, severity of overall pain in ED, belief regarding whether other driver was at fault, and estimated time to physical recovery. The model showed excellent calibration (slope=1.00) and good discrimination between those who develop chronic axial pain and those who do not (AUC=0.76). Cut-off scores with different sensitivity and specificity were generated; specific cut-off score for ED-based preventive intervention studies for high risk individuals can be selected based on the intensity and risks of the intervention. Validation of this predictive tool and further optimization are needed in future prospective studies. Supported by NIAMS R01AR056328.

Worse pain outcomes are observed among individuals seeking monetary compensation after motor vehicle collision (MVC), but whether the etiology of persistent pain among such litigants differs from non-litigants remains poorly understood. One commonly used method for gaining insights into etiology is to evaluate risk factors for disease development. In this prospective observational study, we compared predictors of persistent pain after MVC among litigants and non-litigants. European Americans ≥18 years of age presenting to the emergency department (ED) within 24 hours of MVC who did not have a fracture or injury requiring hospital admission were enrolled. Baseline ED assessment included an evaluation of participant sociodemographic characteristics, pre-MVC health characteristics, MVC history, and participant cognitions and symptoms in the ED. Six week telephone follow-up evaluation assessed litigation status and neck pain intensity during the past week (0-10 NRS), scores ≥4 were defined as moderate/severe neck pain (MSNP). Candidate predictors of six week MSNP were assessed via logistic regression; significance levels were determined using Bonferroni correction (p=0.00125). Six week follow up was obtained in 849/948 (90%) of enrolled participants, and 148/849 (17%) reported that they had hired a lawyer to sue for compensation ("litigants"). MSNP was reported by 95/148 (64%) of litigants and 199/711 (28%) of non-litigants six weeks after MVC. Female sex, increased ED pain severity, and increased ED somatic symptom burden predicted 6 week MSNP among both litigants and non-litigants. Among litigants, unique predictors of 6 week MSNP included not working full time, not having health insurance, and being a vehicle passenger vs. driver. Among non-litigants, unique predictors of 6 week MSNP included believing that the MVC was someone else's fault and increased participant estimate of time to recovery (assessed at ED evaluation). These findings suggest that the etiology of persistent pain in litigants and non-litigants may differ. Supported NIAMS R01AR056328. Worse pain outcomes are observed among individuals seeking monetary compensation after motor vehicle collision (MVC), but whether the etiology of persistent pain among such litigants differs from non-litigants remains poorly understood. One commonly used method for gaining insights into etiology is to evaluate risk factors for disease development. In this prospective observational study, we compared predictors of persistent pain after MVC among litigants and non-litigants. European Americans ≥18 years of age presenting to the emergency department (ED) within 24 hours of MVC who did not have a fracture or injury requiring hospital admission were enrolled. Baseline ED assessment included an evaluation of participant sociodemographic characteristics, pre-MVC health characteristics, MVC history, and participant cognitions and symptoms in the ED. Six week telephone follow-up evaluation assessed litigation status and neck pain intensity during the past week (0-10 NRS), scores ≥4 were defined as moderate/severe neck pain (MSNP). Candidate predictors of six week MSNP were assessed via logistic regression; significance levels were determined using Bonferroni correction (p=0.00125). Six week follow up was obtained in 849/948 (90%) of enrolled participants, and 148/849 (17%) reported that they had hired a lawyer to sue for compensation ("litigants"). MSNP was reported by 95/148 (64%) of litigants and 199/711 (28%) of non-litigants six weeks after MVC. Female sex, increased ED pain severity, and increased ED somatic symptom burden predicted 6 week MSNP among both litigants and non-litigants. Among litigants, unique predictors of 6 week MSNP included not working full time, not having health insurance, and being a vehicle passenger vs. driver. Among non-litigants, unique predictors of 6 week MSNP included believing that the MVC was someone else's fault and increased participant estimate of time to recovery (assessed at ED evaluation). These findings suggest that the etiology of persistent pain in litigants and non-litigants may differ. Supported NIAMS R01AR056328.

Pain syndromes which commonly develop after exposure to traumatic/stressful events are frequently accompanied by substantial co-morbid posttraumatic stress disorder (PTSD) symptoms. Motor vehicle collision (MVC) is perhaps the most common form of civilian trauma, and a strong association between persistent moderate or severe neck pain (PMSNP) and PTSD symptoms after MVC is well documented. The initial weeks after MVC are a critical period of transition to recovery vs. chronic symptom development, and may be a particularly important time period in which to provide treatment/preventive interventions. Such services should ideally include mental health care (MHC) as part of comprehensive pain management, particularly for patients with substantial co-morbid PTSD symptoms. In this study, we evaluated MHC utilization among patients developing PMSNP with substantial co-morbid PTSD symptoms after MVC. Patients presenting to one of six emergency departments (ED) in 3 states were enrolled at the time of ED presentation. Six week follow-up questionnaire included an evaluation of neck pain severity in the past week (0-10 numeric rating scale), PTSD symptoms (Impact of Event Scale-Revised [IES-R]), and MHC use related to the MVC. Patients with neck pain severity score ≥ 4 were defined as having PMSNP; those also with IES-R score > 22 were defined as having substantial co-morbid PTSD symptoms. Among the 427/485 (88%) who completed the six week questionnaire, 165/427 (39%) reported PMSNP, and 84/165 (51%) of these patients suffered from substantial co-morbid PTSD symptoms as well. MHC providers were seen by only a small fraction of patients with PMSNP and substantial co-morbid PTSD symptoms (6/84, 7%). Consistent with previous reports, more than half of patients in this study with PMSNP after MVC have substantial co-morbid PTSD symptoms. However, the receipt of MHC by patients with PMSNP and substantial co-morbid PTSD symptoms after MVC is rare. Funded by NIH 1R01AR056328.

National epidemiological data indicate that 17-25% of women experience rape or attempted rape in their adult lifetimes. When rape survivors seek help in the acute aftermath of the assault, they are likely to turn to the medical system, specifically, Sexual Assault Nurse Examiner (SANE) programs. SANE programs are most commonly located in hospital emergency departments, but may also be located in free-standing clinics or community centers. Rates of survivor treatment with medications to prevent sexually transmitted infection and pregnancy have previously been reported; however, to our knowledge the incidence and treatment of pain symptoms in the acute aftermath of sexual assault has not been assessed. We enrolled 79 [mean(SD) age = 26(7.5)] sexual assault survivors presenting for SANE care to one of 11 SANE treatment centers located in NC, SC, VA, or MD. Study assessments included an evaluation of survivor pain symptoms (0-10 numeric rating scale [NRS] in each of eight body regions) performed by a research assistant at the time of the initial SANE evaluation. Medical records were subsequently reviewed (hospital chart, SANE record) to determine pain medication treatment during SANE care and pain medication prescription at the time of discharge. Pain severity was categorized as follows: 1-3 = mild, 4-7 =moderate, 8-10 =severe. Survivors reported the following pain severity in one or more body regions: no pain [3/79 (4%)], mild pain [7/79 (9%)], moderate pain [27/79 (34%)], severe pain [42/79 (53%)]. Among survivors with severe pain, only 21% (9/42) received any pain medication at the time of SANE exam, and only 2% (1/42) received a pain medication prescription at discharge. These results suggest that severe pain is common in sexual assault survivors receiving SANE care, and that many survivors with severe pain do not receive pain medication treatment.

Traditionally, studies examining persistent post-motor vehicle collision (MVC) pain have focused on the neck region (Whiplash-Associated Disorders), however several recent studies have demonstrated that persistent post-MVC pain is not limited to the neck region. We assessed which regions of body pain are most associated with pain interference and other health outcomes 6 weeks after MVC using data from a prospective, multisite, longitudinal study of patients (n = 427) enrolled in the emergency department after MVC. Among patients reporting persistent post-MVC pain in one or more body regions 6 weeks after MVC (n = 321), we examined the strength of association (assessed via unstandardized beta regression coefficient) between pain severity (0-10 numeric rating scale) in each body region (Regional Pain Scale) and MVC-related pain interference (Brief Pain Inventory subscales) and other health outcomes: post-traumatic stress disorder (PTSD) symptoms (Impact of Events Scale-Revised), depressive symptoms (Center for Epidemiological Studies Depression Scale), and mental and physical health (Short Form 12 Health Survey MCS, PCS). For each outcome, pain regions were then ranked according to strength of association, and mean rankings across pain interference subscales were calculated. Pain in the neck region had the highest mean ranking across pain interference subscales 6 weeks after MVC, followed by pain in the abdomen, upper back, head, and lower back regions. Pain in the neck region was also most strongly associated with depressive symptoms, physical health, and mental health. Pain in the abdominal region was the next most strongly associated with these three outcomes, and was the pain region most strongly associated with comorbid PTSD symptoms. These findings broadly support an emphasis on the neck region when examining post-MVC pain outcomes, while highlighting the important influence of pain in a number of body regions on pain interference and emotional and physical health outcomes. Funded by NIH 1R01AR056328.

More than 90% of patients presenting to US emergency departments (EDs) for evaluation after motor vehicle collision (MVC) do not have serious physical injury. The extent and distribution of musculoskeletal pain experienced by individuals in the immediate aftermath of MVC is highly variable; reasons for vulnerability to musculoskeletal pain after MVC remain poorly understood. We compared the influence of collision-related factors vs. psychological traits on the number of body regions with moderate or severe pain (RMSP) in 414 patients presenting to US EDs for evaluation after MVC. ED evaluation included assessment of crash characteristics (patient report, EMS report, and medical record), pain severity in each body region (0-10 numeric rating scale, NRS), and pre-MVC psychological status (STPI Anxiety and Anger symptoms [Form Y subscales] and depressive symptoms [CES-D]). Moderate or severe pain in a body region was defined by NRS score ≥4. Statistical analyses were performed using negative binomial regression. Only 13% of patients had no RMSP; 33% had 1-2 RMSP; 34% had 3-5 RMSP; and 21% had 6 or more RMSP. The most prevalent RMSP were neck (57%), head (46%), upper back (38%), lower back (36%), and left (24%) and right (22%) shoulder. No collision characteristic (direction, road speed limit, vehicle damage extent) was associated with the number of RMSP. In contrast, depression symptoms and anger symptoms prior to MVC were positively associated with the number of RMSP. For example, patients with 1 or 2 RMSP had mean CES-D score 8.2±0.7 and mean STPI Anger score 16.5±0.5, whereas patients with 6 or more RMSP had mean CES-D score 11.4±1.2 and mean STPI Anger score 18.7±0.7. These results suggest that the extent of pain symptoms in the immediate aftermath of MVC is more strongly influenced by individual vulnerability factors than collision-related factors. Funded by NIH 1R01AR056328.

To date, no longitudinal studies have enrolled sexual assault (SA) survivors in the immediate aftermath of SA and evaluated changes in pain symptoms over time. In this study, we assessed the incidence and distribution of new moderate or severe pain (NMSP) 6 weeks after SA. Women ≥ 18 years of age presenting within 72 hours of SA to one of 11 acute medical treatment centers were recruited. Pain symptom assessments were performed 1 and 6 weeks after assault (0-10 numeric rating scale [NRS] in each of eight body regions). One week evaluation included an assessment of both current pain and pain experienced during the week prior to assault. SA history and participant physical examination/injury information were obtained from treatment center records. NMSP in a body region at 6 weeks was defined by NRS pain score ≥ 4 in a region in which pain score ≤ 3 was reported during the week prior to SA. To date, 64 adult women survivors (mean(SD) age = 26(7.9)) have completed 6 week follow-up. NMSP was present in 27/64 (42%) of SA survivors: 10/64 (16%) had NMSP in 1 body region, 6/64 (9%) had NMSP in 2 body regions, and 11/64 (17%) had NMSP in ≥ 3 regions. NMSP was most common in the back (17, 22%), abdomen (13, 20%), neck (12, 19%), and head or face (12, 19%). In the majority of body regions with NMSP (71%), there was no historical or physical evidence of trauma at the time of assault. These results suggest that one or more regions of NMSP are common 6 weeks after assault in SA survivors. Regions of NMSP are not limited to genital/pelvic regions or regions experiencing substantial trauma. Further studies are needed to better understand the development of pain symptoms after SA.

Women with a history of sexual assault commonly report chronic pain. However no prospective studies have examined onset of pain symptoms following sexual assault among survivors. We are conducting an ongoing prospective study examining the incidence and distribution of pain symptoms among women presenting for Sexual Assault Nurse Examiner (SANE) care within 72 hours of sexual assault. Research study sites include a network of 12 SANE programs in North Carolina, South Carolina, and Virginia. Consenting survivors complete initial symptom assessment at the time of SANE exam. Survivors subsequently consenting to the full study receive follow-up interview assessments 1 week, 6 weeks, 3 months, and 6 months after assault. Assessments include reported pain intensity (0-10 numerical rating scale [NRS]) in 8 body regions. Those with NRS ≥4 in ≥ 1 body region were defined as being in moderate or severe pain. To date, thirty one survivors (mean(SD) age = 26(7.0)) have completed enrollment and received at least one follow-up assessment. Eighty four percent (26/31) of survivors had moderate or severe pain at the time of initial evaluation (most commonly in genital (52%), head and face (39%), and neck (26%) regions). No (0/31) survivors were prescribed pain medication at the time of SANE discharge. Seventy-one percent (22/31) of survivors had moderate or severe pain 1 week after assault (most commonly in abdomen (52%), genital (45%), and head and face (26%) regions). Fifty percent (12/24) of survivors continued to have moderate or severe pain 6 weeks after assault (most commonly in abdomen (25%), genital (21%), and neck (21%) regions). Only 13% (2/16) of patients with continued moderate or severe pain at 6 weeks were receiving pain medication. More research is needed examining pain incidence and distribution and optimal treatments for pain in sexual assault survivors.

Chronic pain is commonly reported by sexual assault (SA) survivors years after assault, but no information is available regarding the characteristics of patients experiencing pain in the early aftermath of SA. Such information may provide improved insight into the experience of SA survivors and better define those at highest risk for persistent pain. We are currently conducting a prospective study of women presenting for Sexual Assault Nurse Examiner (SANE) care within 72 hours of sexual assault. Consenting survivors complete longitudinal symptom assessments including evaluation at the time of SANE visit and 1 week after assault. Correlations between pain intensity (0-10 numeric rating scale) and psychological characteristics (Peritraumatic Distress Inventory (SANE visit) and Acute Stress Disorder (ASD) Scale (1 week)) were compared using Spearman's rho. To date, 31 female SA survivors (mean (SD) age = 26(7.0)) have completed SANE and 1 week follow-up evaluations. Mean (SD) pain scores at these time points were 6.9 (3.1) and 5.8 (3.5), respectively. Psychological characteristics during assault that were most strongly correlated with overall pain score at the time of SANE exam were feeling that might pass out (r = .605, p = .001), feeling in a dream (r = .502, p = .005), and feeling in a daze (r = .445, p = .016). One week after SA, overall pain score was correlated with ASD score (r = .459, p = .014). Individual ASD scale items most strongly correlated with pain 1 week after SA included feeling jumpy since assault (r = .570, p = .001), being unable to recall important aspects of the assault (r = -.519, p = .004), and feeling irritable since assault (r = .496, p = .006). Further research is needed to understand individual characteristics associated with pain experiences after SA.

Each year, approximately 4 million people are evaluated in United States Emergency Departments (ED) after experiencing motor vehicle collision (MVC) and discharged to home. North American studies indicate that 10%-20% of these individuals develop persistent post-MVC neck pain. Evidence from a variety of pain conditions suggests that African Americans (AA) may have increased vulnerability to pain compared to European Americans (EA). However, rates of post-MVC neck pain in AAs and EAs have not previously been compared. In this investigation we assessed rates of acute and persistent post-MVC neck pain in EA vs. AA individuals presenting to the ED after MVC. ED assessment included an assessment of demographic characteristics, neck pain severity (0-10 NRS), and peritraumatic distress (Peritraumatic Distress Inventory). One month follow-up assessment included an evaluation of neck pain severity (0-10 NRS) and posttraumatic stress disorder symptoms (Impact of Event Scale-Revised). To date, 129 patients have been enrolled in this ongoing study (22 AA and 107 EA). In the ED, AAs had more intense neck pain than EAs (5.3(3.4) vs. 3.2(3.1), p = .011), and had greater peritraumatic distress (25.5 (9.9) vs. 19.9 (9.6), p = .022). One month after MVC, AAs had more PTSD symptoms than EAs (37.4 (18.5) vs. 18.8 (17.4), p <.0001), and a trend toward greater neck pain (3.0 (3.8) vs. 1.7 (2.8), p = .146). These preliminary data suggest that AA may experience increased rates of pain and psychological sequelae after MVC. Whether these differences are due to lower socioeconomic status, greater life stress, challenges associated with racism and discrimination, and/or genetic differences is not known. Further studies are needed comparing pain and psychological symptom outcomes after MVC in EA vs. AA individuals. (Supported by Grant 5R01AR056328-02 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.)