20 September 2021

Chronic pain affects driving

Clinical Pain Rheumatology

Pain may hurt physical and cognitive functioning, making driving risky for people who suffer from the chronic condition.

In a study recently published in Arthritis Care and Research, researchers observed the typical driving habits of 33 rheumatoid arthritis patients and 23 healthy participants across almost 1300 cumulative driving hours. They collected data using sensor-based instrumentation installed in the participants’ vehicles.

Rheumatoid arthritis participants demonstrated lower braking and accelerating variability than controls on residential roads where lower speed limits were enforced. Those with low disease activity also showed lower steering variability.

But on interstates and highways where enforced speed limits are higher, rheumatoid arthritis was associated with increased steering variability among those with moderate-to-high disease activity.

In addition, worsening rheumatoid arthritis disease activity and arthritis-related decrements in physical functioning over 12 weeks of observation were associated with harsher braking and accelerating at higher speeds on interstates and highways.

Car crashes are a significant public health concern and cause more than 1 million fatalities and 50 million injuries each year globally.

According to a systematic review recently published in the journal PAIN, people experiencing chronic pain reported difficulties with physical driving tasks and cognitive performance, and this might increase the risk of a crash.

Participants with chronic pain variously reported difficulty changing lanes, merging in traffic, turning, steering and cornering. Those with fibromyalgia experienced more problems during manoeuvres than those with low-back pain.

People with chronic pain also reported difficulty with specific strategic driving activities, including driving alone, in heavy traffic, at night and for long distances.

“The first problem I had was holding the clutch with my left foot in a manual car,” said Jackie Morris, 66, who was diagnosed with rheumatoid arthritis more than 40 years ago. She said she has to adjust her driving position depending on what part of her body flared and plan long trips carefully to include plenty of breaks.

“Driving is a complex task that requires the ability to identify the hazard and react appropriately and quickly to avoid a crash,” said Dr Atiyeh Vaezipour, a research fellow at Recover Injury Research Centre at the University of Queensland and one of the authors of the review. “Chronic pain can impact the physical and cognitive functioning required for safe driving.”

But the subjective nature of chronic pain and the demographic variability of people with chronic pain make it challenging to inform clinicians and policymakers with clear guidelines, she said.

Dr Oscar Oviedo-Trespalacios, a transportation safety expert at the Queensland University of Technology (QUT) and an author of the review, said road safety policies don’t take human health into account. More research is needed in the field to develop clear advice, he said.

The matter is particularly important in a country such as Australia, where many people rely heavily on driving.

“Especially for people who live in rural and remote areas, driving cessation could be associated with less independence, reduced community participation and overall reduced quality of life,” said Dr Vaezipour.

To Ms Morris, “driving is a necessity”.

“I’m no longer able to walk even small distances,” she said. “I depend greatly on my driving ability.”

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