300 Section - Neurological Sequelae Following Severe Traumatic Injuries: Incidence and Care Patterns Across Two Nationwide Retrospective Cohorts in Korea

Despite the high burden of chronic pain after severe trauma, research on this condition remains limited. This study compared the 1-year incidence of complex regional pain syndrome (CRPS) and fibromyalgia after severe trauma between two independent population groups covered by the National Health Insurance Service (NHIS) and Automobile Insurance (AUI) in Korea, and evaluated their healthcare utilization, including outpatient visits and analgesic use.

Design: This nationwide retrospective cohort study used two medical claims databases. In NHIS, 11,288 of 613,253 severe trauma patients (2014–2021) developed CRPS or fibromyalgia within 1 year. In AUI, 1,944 of 245,674 patients developed these sequelae. To examine temporal trends in incidence, we applied Joinpoint regression to estimate the average annual percent change (AAPC). Median number of multidisciplinary outpatient visits was assessed. Analgesics use rates were examined in the AUI cohort.

Results:

In both NHIS and AUI, the incidence of neurological sequelae rose initially and then began to decline around 2017. Especially, CRPS I incidence decreased sharply after 2019, with AAPCs of −30% (NHIS) and −49% (AUI), whereas fibromyalgia incidence rose from 2014 to 2019 in both systems. Median outpatient visits to neurologists, anesthesiologists, and physiatrists were higher in NHIS than in AUI. In the AUI cohort, annual use rates ranged from 83–92% for weak opioids, 51–73% for gabapentin, and 37–68% for pregabalin; only pregabalin showed a significance. Weak opioid and pregabalin use were more common in CRPS, whereas gabapentin use was higher in fibromyalgia.

Conclusion:

Although the incidence of neurological sequelae was higher in NHIS than in AUI, both populations showed similar temporal patterns. The declining incidence of CRPS and rising incidence of fibromyalgia may reflect shifts in diagnostic patterns or injury profiles, warranting further investigation. Tailored clinical and policy strategies are needed to address chronic pain after severe trauma.