Effect of chronic nonmalignant pain on highway driving performance

Veldhuijzen, Dieuwke S.; van Wijck, Albert J. M.; Wille, Frank; Verster, Joris C.; Kenemans, J. Leon; Kalkman, Cor J.; Olivier, Berend; Volkerts, Edmund R. · 2006 · OpenAlex-citations

DOI: 10.1016/j.pain.2005.12.019

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Summary

This study investigated whether chronic nonmalignant pain impairs actual highway driving performance, addressing a gap in literature where cognitive deficits in pain patients were known, but their impact on real-world driving remained unclear. The research aimed to isolate the effects of pain itself from those of pain medication, as previous studies often conflated the two. The researchers conducted a controlled experiment involving 14 patients with chronic nonmalignant pain and 14 healthy controls, matched for age, educational level, and driving experience. Participants underwent a standardized on-the-road driving test on a 100-km primary highway during normal traffic conditions. The primary metric for driving performance was the Standard Deviation of Lateral Position (SDLP), which measures lane-keeping stability. Additionally, participants completed laboratory tests assessing tracking, divided attention, and memory, as well as subjective ratings of pain intensity, alertness, and perceived driving quality. Statistical analyses included ANOVA with IQ and gender as covariates to account for baseline differences. The results demonstrated a statistically significant difference in highway driving performance between the two groups. Pain patients exhibited a higher mean SDLP (25.2 cm) compared to healthy controls (20.7 cm), indicating worse lane-keeping ability. This difference of 4.5 cm persisted throughout the driving task and remained significant even after adjusting for IQ and gender. Notably, a subset of pain patients showed SDLP values exceeding those of the controls, while others performed within the normal range. In contrast, no significant differences were found between groups on the laboratory tests for tracking, memory, or divided attention. Subjectively, pain patients rated their driving quality as "normal" but significantly lower than controls, and they reported significantly lower alertness levels both before and after the drive. The findings suggest that chronic nonmalignant pain can impair actual driving performance, specifically lane-keeping stability, despite preserved performance on isolated cognitive tasks. The observed impairment in pain patients was comparable to the effect of alcohol consumption at a blood alcohol concentration of 0.08%, which is associated with a tripling of accident risk. The discrepancy between impaired on-road performance and normal laboratory results highlights the limitations of using isolated cognitive tests to predict real-world driving ability. The study concludes that pain itself may compromise driving safety, necessitating further research to identify specific cognitive mechanisms, such as vigilance or attentional capacity, that are affected.

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