Table 2. Key Question 4 Studies: Patients with polytraumatic injuries other than or in addition to traumatic brain injury.

Study	Design and Sample	Pain-Related Outcomes Measured	Analytic Method	Results
Anke et al. 1997 [73]	Retrospective cohort; 69 pts. with severe multiple trauma (Oslo, Norway)	Injury severity, social network, impairments, pain; 35 months post-injury	Descriptive; bivariate comparisons	Twenty-nine percent reported moderate to unbearable pain. Pain was significantly correlated only with loss of non-work activities.
Brenneman et al. 1997 [85]	Retrospective cohort; 27 blunt trauma victims with open or closed pelvic fracture	Bodily pain (SF-36), FIM, and Global health assessment; avg. 4 years post-injury	Bivariate comparisons	Patients scored significantly worse on bodily pain and global health than age-specific population norms. No difference found between open fractures group vs closed fractures group; Bodily pain: 55.6 vs 66.1, P = n.s.
Brenneman et al. 1997 [70]	Prospective cohort; 195 survivors of blunt trauma (Ontario, Canada)	Bodily pain (SF-36); Return to work (RTW); 1 year post-injury	Bivariate comparisons; Logistic regression	Reported bodily pain significantly worse at both discharge and year 1 for those unemployed at year 1.
Dimopoulou et al. 2004 [74]	Prospective cohort; 87 multiple-trauma inpatients (Athens, Greece)	Nottingham Health Profile, Rosser Disability Scale; 1 year post-injury	Descriptive; logistic regression	Forty-one percent of patients had pain 1 year after ICU discharge. Injury severity and severe head trauma predicted both poor health-related quality of life and disability.
Dougherty 1999 [79]	Retrospective cohort; 23 veterans with bilateral above-knee amputations; 145 men who completed national survey	Bodily pain (SF-36); avg. 27.5 years post-surgery	Bivariate comparisons	Amputation group scored lower than control group on physical functioning scale of the SF-36. Comparisons on the other seven subscales (including bodily pain) revealed no significant differences.
Dougherty 2001 [69]	Retrospective cohort; 72 pts who underwent transtibial amputation in Vietnam War	Bodily pain (SF-36); avg. 27.5 years post-surgery	Multivariate comparisons	The patient group with more than one amputation or additional injury, but not the single-amputation group, reported significantly worse pain scores than matched controls.
Fitzharris et al. 2007 [86]	Prospective cohort; 62 inpatients injured in motor vehicle accidents (Australia)	Bodily pain (SF-36) and 100-pt VAS; discharge, 2 and 8 months post-discharge	Multivariate comparisons	Pain scores (VAS) remained significantly higher at 8 months post-accident than pre-accident even though pain improved between 2 months and 8 months post-accident. Bodily pain scores (SF-36) were significantly worse 8 months post accident for males, but not females.
Frink et al. 2007 [78]	Retrospective cohort; 26 patients treated for compartment syndrome	Reported pain during extension exercises; avg. 2.4 years after hospital admission	Bivariate comparisons	No significant differences between polytrauma and single injury in muscular strength, range of motion, or pain.
Hebert & Burnham 2000 [65]	Prospective cohort; 830 inpts with traumatic spine injury with or without neural injury	FIM; 1 and 2 years post-injury	Linear regression	Pts with higher injury severity more likely to have incapacitating pain vs occasional pain at 1 year and more likely to have incapacitating pain vs no or occasional pain at 2 years
Holtslag et al. 2007 [75]	Prospective cohort; 311 severely injured patients, majority polytrauma (Netherlands)	Health status (EQ-5D), disability (GOS), Head injury symptoms, comorbidity; 12 to 28 months after trauma	Multivariate logistic regression	Factors associated with lower EQ-5D scores: Education; Comorbidity; Education; Brain Injury; Spinal cord injury and lower extremity injury. Factors significantly predicting pain scores: comorbidity, lower extremity injury.
MacKenzie et al. 1998 [87]	Prospective cohort; 312 pts. admitted for blunt, unilateral lower extremity fracture distal or including the acetabulum	Physical range of motion and muscle strength (impairment), Time to return to work (RTW), Pain (VAS); prior to discharge, 6 and 12 months post-injury	Cox proportional hazards regression adjusted for effect of pain and impairments.	Pain highly correlated with impairment and RTW. RTW percentages within 12 months of injury were 85%, 73%, and 51%, for VAS mean pain scores of <10, 10–19, and ≥30, respectively. Pain did not a predict RTW after adjusting for impairment.
Meerding et al. 2004 [76]	Prospective cohort; 1,806 patients with injuries including polytrauma (Netherlands)	Health Status (EQ-5D), return to work status and duration of absence; 2, 5, and 9 months after surgery	Multivariate regression	Number of injuries predicted health status and duration of work absence. Pain at 2 months was most prevalent in women, older pts., patients hospitalized ≥7 days, and pts. with hip fracture.
Mkandawire et al. 2002 [71]	Prospective cohort; 158 inpatients, majority polytrauma (Wales)	Functional disability (Bull disability scale), pain; 5 years post-injury	Descriptive	Forty-five percent of patients with single fractures and 91% of patients with multiple fractures had residual disability, while 26% and 60%, respectively, were experiencing moderate or severe pain.
Pezzin et al. 2000 [9]	Retrospective cohort; 78 patients who underwent trauma-related amputation	Injury characteristics and treatment, health and injury problems, bodily pain (SF-36); avg. 7.5 years post-discharge	Descriptive; bivariate comparisons; logistic regression	Twenty-four percent of pts reported severe phantom pain, 24% reported wounds/sores in residual limb in the past month. Seventeen percent reported severe pain in the contralateral limb. Number of nights spent on inpt. rehabilitation service marginally associated with pain score and return to work in adjusted multivariate analyses.
Roganovic and Mandic-Gajic 2006 [67]; Roganovic and Mandic-Gajic 2006 [68]	Retrospective cohort; 326 veterans/active military pts. w. missile-caused nerve injuries (Serbia)	Pain syndromes, pain intensity (before and after tx); post-operative and ≥1 year follow-up	Multivariate regression	Type of pain syndrome, multiple nerve damage, and early onset of pain predict initial pain intensity. Type of pain syndrome, severity of nerve injury, and absence of pain paroxysms predict positive treatment outcomes.
Soberg et al. 2007 [80]	Prospective cohort; 101 patients with multiple injuries, NISS ≥16 (Oslo, Norway)	Bodily pain (SF-36), cognition (COG), disability (WHODAS II), injury characteristics; at injury, discharge, 1 and 2 years post-injury	Bivariate comparisons; multivariate regression	At 2 years, patients reported worse health scores on SF-36 compared with general population; time from injury to return home, social functioning and physical functioning predicted disability.
Stalp et al. 2002 [82]	Prospective cohort; 254 polytrauma patients (Germany)	Pain (MFA, SF-12, HASPOC), disability (GCS), ISS; avg. 2.2 years post-injury	Descriptive; bivariate comparisons	Injuries below knee significantly more limiting; in patients reporting pain and restrictions of the lower extremity: 52% caused by foot and ankle injury, 31% knee or thigh, and 17% femur or hip.
Turchin et al. 1999 [84]	Prospective cohort; 56 matched, multiply injured patients with (group1) and without (group 2) foot injury	Pain (SF-36), Osteoarthritis (WOMAC), foot and ankle trauma (Modified Boston Children's Hospital Grading System); avg. 62 months	Bivariate comparisons	Multiply injured patients with foot injuries reported significantly worse health than patients without foot injuries for each of the three outcome measures.
Ulvik et al. 2008 [52]	Retrospective cohort; 210 polytrauma inpatients (Norway)	Pain/discomfort (EQ-5D); 2–7 years post-injury	Logistic regression	Patients without severe head injury reported more problems with pain/discomfort. Years since trauma was negatively associated with pain/discomfort.
Urquhart et al. 2006 [64]	Prospective cohort; 357 pts with isolated orthopedic injury, 659 with multiple ortho. injuries, 165 w. additional injuries (Australia)	Pain (VAS, SF-12), disability, work status (SIPw); 6 months post-injury	Bivariate comparisons	Marginally significant difference in proportion of patients reporting moderate/severe pain: 47% of additional injuries, 37% of multiple ortho. injuries, and 33% of isolated orthopedic injuries.
Vles et al. 2005 [72]	Prospective cohort; 166 trauma inpatients with an ISS ≥16 (Netherlands)	Pain/discomfort (EQ-5D), disability (GOS), return to work status; 1 year post-injury	Multivariate regression	Factors associated with pain or discomfort (5Q-5D): ISS ≥25; female gender; injury to the chest or thoracic contents; and injury to remaining body areas
Zelle et al. 2005 [66]	Retrospective cohort study; 389 polytrauma pts. with one or more lower-extremity fractures (Germany)	Pain (SF-12), polytrauma outcome (HASPOC), Tegner activity score, inability to work; 10+ years post injury	Multivariate regression	Fractures below the knee joint associated with persisting pain and inability to work.

ANOVA = analysis of variance; COG = cognitive function assessment derived from SF-36; EQ-5D = EuroQol-5D, a measure of health outcome by the EuroQol Group; FIM = Functional Independence Measure; ICU = Intensive Care Unit; SF-12 = 12-item short form Health Survey, a subset of SF-36; NISS = New Injury Severity Score; NHP = Nottingham Health Profile; RTW = Return To Work; SF-36 = 36-Item Short Form Health Survey; VAS = Visual Analog Scale; WHODAS II = World Health Organization; WOMAC = Western Ontario and McMaster Osteoarthritis Index; GOS = Glasgow Outcomes Scale; MFA = Musculoskeletal Function Assessment; HASPOC = Hannover Score for Polytrauma Outcome; SIPw = Work subscale of sickness impact profile.