From: Eur Neurol. 2010 Aug 18;64(4):214-218. [Epub ahead of print]

The objective of this study was to estimate the incidence of posttraumatic dissections of cervical arteries in patients with whiplash injury acquired in a car accident. The authors performed a retrospective analysis of medical records of 500 patients with whiplash injury acquired in car accidents between 1996 and 2005 and searched for dissections of cervical arteries occurring within 12 months after injury. Eight cases of cervical arterial dissection occurred within 12 months following whiplash injury. In 7 cases (87.5%), the dissection was complicated by brain infarction. The incidence of posttraumatic dissections after whiplash injuries was much higher than the overall incidence of cervical arterial dissections in the general population. The risk of cerebrovascular events was still increased 4-12 months after whiplash injury vs. the general population.

There is an increased risk of posttraumatic dissection and cerebrovascular events within 12 months after whiplash injury. Car accident is an important risk factor for arterial dissections. The victims of car accidents should be screened for arterial dissections. The results of this study should be more thoroughly investigated in a prospective trial of car accident victims as a risk factor for arterial dissections.

From: Injury. 2010 Jul 31. [Epub ahead of print]

People with Whiplash Associated Disorder often experience pain and disability for extended periods of time. A large proportion of these people will seek treatment through a compensation process. Rarely is data related to people’s health collected within the compensation process making it difficult to identify those that are at risk of delayed recovery and appropriately direct interventions.

To compare people with whiplash associated disorder who have recovered with those that have not, within 3 months of injury and identify potential predictors of poorer health and non-recovery to inform claim screening processes. People who sustained a whiplash associated disorder and claimed compensation within an Australian Motor Accidents Compensation Scheme between November 2007 and June 2009 participated in the study.

Recovery indicated by Functional Rating Index score less than or equal to 25. Outcome measures were Short Form 36 (SF36), FRI, and the Pain Catastrophising Scale. 246 people who had lodged a claim for compensation were enrolled in the Whiplash Outcome Study within 3 months of sustaining a whiplash associated disorder injury. Participants were assigned to a recovered or non-recovered group and analysed for differences between the two groups. Multiple linear regression models were used to identify potential predictors of poorer health and non-recovery.

Overall 23% of the study population had recovered within 3 months of sustaining a whiplash associated disorder, while only 9% had finalized their insurance claim. The recovered group had significantly better scores on all health outcome measures; SF36 Physical Component Score, SF36 Mental Component Score and the Pain Catastrophising Scale. The significant independent predictors of poorer health and non-recovery were helplessness, older age and pre-injury work status being affected. Regardless of the health outcome measure used, helplessness was significantly associated with poorer reported health.

Including additional information at claim notification, specifically the Pain Catastrophising Scale and information on the effect the injury has on the working population could significantly improve claim screening processes, identifying those with poorer health and risk of non-recovery.

Related Sources:

Physical and psychological factors maintain long-term predictive capacity post-whiplash injury

A prospective cohort study of health outcomes following whiplash associated disorders in an Australian population

From: BMC Musculoskelet Disord. 2010 Jul 13;11(1):158.

Whiplash was defined in 1995 by the Quebec Task Force as a neck injury mechanism and may result in injuries within the musculoskeletal and /or neurological system. The Quebec Task Force developed a system for grading Whiplash Associated Disorders : whiplash associated disorders I-II (symptoms without known pathology), III (symptoms and neurological signs), and IV (symptoms and cervical fracture and/or dislocation).

Grade I and II patients represent up to 90 % of “whiplash injury claims”. The proportion of patients who reports pain and disability six months after the accident (i.e. chronic whiplash associated disorders) varies substantially between studies and countries. However, a recent review suggests that approximately 50% of the patients with whiplash associated disorders will report neck pain symptoms one year after their injuries. Patients with chronic whiplash associated disorders report high levels of neck pain, headache, and shoulder pain often accompanied by neck stiffness, dizziness, fatigue, sleeping problems, concentration problems, allergy, breathing disorders, hypertension, cardiovascular disorders, digestive disorders, depression, anxiety, and impairment in cognitive performance. A recent study of a large population-based cohort of victims of car accidents, found that isolated neck pain was rare and that pain from multiple body areas was most commonly reported.

Expectations and coping styles might influence the outcome and prognosis after whiplash injuries. The Cognitive Activation Theory of Stress describes stress response as a general normal, healthy, and necessary alarm. There may be a risk of illness and disease only if the arousal is sustained. The level and duration of the alarm depends on the expectancy of the outcome of stimuli, as well as the results from specific responses available for handling the situation. Therefore, the cognitive activation theory of stress model emphasizes the importance of coping as positive response outcome expectancies. This means that if the individual expects to be able to handle a situation with a positive result (coping), the activation will be short and do no harm. Kivioja et al. found no evidence that early coping strategies influenced the prognosis after whiplash injuries. Others, however, found that high levels of passive coping strategies are associated with a slower recovery after whiplash injury, and that certain coping strategies for pain, such as catastrophizing, is associated with increased risk of disability, and that the importance of coping strategies seem to increase over time. In general, there is considerable controversy as to the importance of psychological factors for developing chronic whiplash associated disorders.

The importance of insight into coping strategies has been emphasized for chronic pain patients such as fibromyalgia, tension-type headache, chronic back pain, and chronic temporomandibular disorder. However, there is little qualitative insight into the ways persons with chronic whiplash associated disorders cope on a day to day basis. Such insight may provide the clinician with a better understanding of lay health recourses, and, possibly, provide a better starting point for suggesting strategies or discussing potentially maladaptive strategies to patients suffering pain following whiplash. Furthermore, Russell & Nicol suggested that whiplash associated disorders patient recovery may be increased if the clinicians better understand patient experiences. In the present study the authors identify what is described as dominant whiplash symptoms, and the behavioral strategies used to cope with whiplash associated disorders.

The aim of the present study was to identify dominant whiplash symptoms, and the behavioral strategies used to cope with these. Participants stated dominating symptoms to be neck and head pain, sensory hypersensitivity, and cognitive dysfunction. In describing their dominating symptoms participants gave emphasis to a fluctuating level of pain – dividing their life into what they described as a repeating cycle of good and bad periods. To cope with these symptoms, maintaining the good periods and avoiding or shorten the bad periods, they used rest, exercise, and social withdrawal. Participants expressed a constant notion of alternating or balancing between these coping strategies following the intensity of symptoms, or the expectancy of participating in situations or events that might trigger pain.

Participants reported severe neck and head pain, sensory hypersensitivity, and cognitive dysfunction as their main complaints. These symptoms are reported in several other studies. The pain was not described as being on a permanent level, but, rather, as fluctuating from a severe and intolerable level of pain to a more manageable pain. This fluctuating pattern was by the participants described as having bad and good periods. The symptoms were closely connected together as one could cause the onset of the other. Such a pattern of fluctuating pain and incapacity which is difficult to predict and manage, has also been reported in other studies on chronic pain, and it affects not only own health, but also family life and social activities.

A main finding in this study was how participants divided everyday life into good and bad periods, and how they adjusted their coping strategies according to this. Participants expressed a constant notion of alternating between or balancing their three main coping strategies; rest, exercise, and social withdrawal. If the balance – viz choosing and implementing the best strategy – was not maintained pain could be triggered or bad periods prolonged. The strategies were, primarily, chosen based on the intensity of symptoms, but it was also reported in the focus groups that the same strategies, mostly rest and social withdrawal, were used as means to prepare for, or unwind from, possible pain triggering situations or events.

Lazarus & Folkman’s cognitive-phenomenological model of stress and coping discriminates between active and passive coping strategies. Active or problem-focused strategies are used to target the source of stress and reduce it, whereas passive or emotional-focused strategies are mostly concerned towards adapting to the stress or problem. Most of the participants in this study used exercise, i.e. active coping strategies in good periods as they experienced that it reduced pain. Passive coping strategies, such as rest and social withdrawal, were mostly used to endure pain and to maintain the important balance as the participants were afraid of provoking bad periods. Social withdrawal may be interpreted as a direct consequence of their lifestyle changes, but participants also perceived it as a coping strategy per se – primarily used to avoid triggering the pain brought on by being exposed to noise, concentrating, or focusing too much.

Contrary to the Lazarus use of coping strategies, the Cognitive Activation Theory of Stress suggests that it is not the strategy or way of coping that is the most important issue, but the expectancy of the result. In the good periods our participants engaged in behaviors they expected to improve their circumstances – regular exercise being the most important one. The use of rest and social withdrawal were also used in good periods as a way of ‘charging the batteries’ for special events. The participants expected and experienced positive results of these behaviors, i.e. coping in the terminology of the cognitive activation theory of stress model.

However, what participants referred to as bad periods was characterized by unremitting pain often leading to frustration, depression, and social isolation. The participants had to socially withdraw and rest during these periods. In bad periods they felt that the symptoms took control of them, and that there was nothing they could do but rest and wait for a good period. Several participants experienced depression due to their situation. Within the cognitive activation theory of stress model helplessness or hopelessness develops when there is either no relationship or a negative relationship between what the individual attempts to do and the outcome. This may lead to sustained arousal, which, in turn, could lead to illness and disease such as depression and chronic fatigue syndrome.

The participants expressed that, to some degree, they could control or predict bad periods; consequently they tried to balance their life to avoid these periods. The constant notion of trying to balance; the restrictions and sacrifices behind their coping strategies took its toll on everyday life. The pattern of coping strategies described in this study was in accordance with other studies on patients with chronic pain, and was perceived as effective for these participants. However, it could be discussed whether or not the behavioral strategies, even though they might lead to positive response outcome expectancies, are adaptive or not. Most participants expressed a wish to be able to participate in working life. Nevertheless, only three in 14 participants had been able to maintain a work situation. So, although the strategies used were considered the most beneficial – or the only way to adjust their life, it is questionable whether or not they led to progress or just maintained the pattern of alternating good and bad periods. Knowledge of patients’ self-initiated coping strategies may give the clinician a better understanding of the patients’ frame of reference; how they organize everyday life to cope with their problems, and, accordingly, establish a better starting point for discussing potentially maladaptive strategies.

Participants reported severe neck and head pain, sensory hypersensitivity, and cognitive dysfunction as their main complaints. To cope with these complaints, and their fluctuating nature, three main strategies were used; rest, exercise, and social withdrawal. The participants portrayed that maintaining a balance between these coping strategies helped control the pain.

From: BMC Res Notes. 2010 Jul 13;3(1):190.

The incidence rate of whiplash injuries in Sweden is estimated to be 1.0-3.2/1000 /year. The injuries constitute a major health problem in Western society due to the large number of people with Whiplash associated disorder and the high economical costs associated with whiplash associated disorder. People with acute whiplash associated disorder, mainly complain of neck pain, stiffness, headache and dizziness. Other symptoms that may occur after the injury are fatigue, concentration and memory problems. Most subjects with acute whiplash associated disorder are reported to recover within three months of the trauma however, a significant number of persons experience symptoms several years after the accident. Persistent neck pain has been reported in 84-90% one to two year and in 55% 17 years after the injury.

It is still unclear why pain and related symptoms do not resolve after the expected time of healing and which factors are involved in the persistence of symptoms and impairments after the trauma. A bio-psycho-social model is often used to describe the complex interaction of physical and psychological factors in the development of chronic whiplash associated disorder. The long lasting problems after the injury may also interfere with occupational activities, the number of persons on sick-leave or unable to perform their ordinary duties six months after whiplash associated disorder have been reported to vary between 13 and 50%. In addition, chronic whiplash associated disorder may also affect leisure and daily life with social contacts and the total experience of life satisfaction.

Many studies of long-term problems after whiplash associated disorder have primarily focused on symptoms, especially neck pain in people seeking health care but fewer studies have investigated the long-term effects on activity/disability and life satisfaction. In addition, less is known about the differences between subjects who consider themselves as recovered and those who suffer from persistent disability. Sterling et al investigated post-traumatic stress in relation to disability on the Neck Disability Index during the first six months after whiplash injury. They found that persons who reported themselves to be recovered or to have mild disability six months post trauma reported decreased post-traumatic stress scores in comparison with early after the injury, whereas persons with moderate/severe disability reported persistent post-traumatic stress scores into the chronic stage.

In a scientific as well as in a clinical context, the need of studying subgroups of subjects has been proposed. Information about the characteristics of these groups may provide help to develop adequate treatments. Since the levels of disability seems to be of importance in whiplash associated disorder, this study aimed to assess the difference in symptoms, psychological factors and life satisfaction between subjects who were classified as recovered and those who suffered from mild/severe disability based on the Neck Disability Index. In addition, this study examines whether the Neck Disability Index is a clinically useful tool to classify whiplash disability.

Although previous studies have investigated disability in whiplash patients, to the authors knowledge this study is the first to investigate differences in pain intensity, symptoms, posttraumatic stress, depression, and life satisfaction between subjects with persistent disability and subjects classified as recovered in a “non-help-seeking” population long time after whiplash injury.

In the present study the Neck Disability Index was used to assess and to classify disability in according to a previous study. In their study of whiplash patients six months post trauma, the Neck Disability Index scores were slightly lower in comparison with the three subgroups in the present study. Regardless of the time difference between the two studies, it seems possible to assume that the character of disability in persons with whiplash associated disorder around half a year after the injury may persist for longer time. The results on the Neck Disability Index in our study also agree with the scores reported three years and 17 years after the injury.

In accordance with previous studies of whiplash associated disorder, neck pain was the most commonly reported symptom in the moderate/severe and the mild groups. These frequencies were close to results (55 %) reported 17 years after the injury. However, pain was also reported in the recovered group, but the frequencies of pain locations (neck, upper and lower back pain) were more equal. Among the whiplash related symptoms, cognitive deficits with poor concentration and poor memory were unexpectedly high both in the recovered group (25%) and in the moderate/severe and mild groups (60-93%). Since chronic pain, depression and post-traumatic stress may affect cognitive symptoms, these factors might have contributed to the cognitive disturbances in all groups in the present study.

The highest post-traumatic stress scores were reported in the moderate/severe group and the frequency of distinct post-traumatic stress reaction (36.3%) was clearly higher than reported in whiplash patients early after injury (13%). Some evidence for an association between greater post-traumatic stress and late whiplash syndrome has been shown. However, since the levels of post-traumatic stress were high especially in the moderate/severe group, these findings may support the recommendation of early diagnoses and treatment of acute stress to minimize the risk for long-lasting symptoms.

Chronic whiplash associated disorder may have a negative impact on quality of life. When comparing life satisfaction on the LiSat-11 between the three disability groups in our study with a large population-based Swedish reference group (2533 subjects), the mild and moderate/severe groups showed lower levels of life satisfaction. However, significant differences were found between the moderate/severe group and the recovered group in eight of eleven domains. Previous research has shown that depression influences outcome for quality of life in chronic whiplash associated disorder and the significantly higher BDI scores in the moderate/severe group may have contributed to their low life satisfaction. Moreover, the association between depression and non-recovered in the multivariate analysis indicates the importance of assessment and treatment of depression in whiplash associated disorder-patients.

This study has implications for clinicians. Although symptoms often are reported after whiplash injury, the activity levels may differ. Due to the complexity of whiplash associated disorder, the importance of identifying subgroups of whiplash associated disorder has been proposed in order to better tailor their treatment. In a previous study, Neck Disability Index was found to be the most sensitive instrument among several questionnaires to predict poor outcome. Our study adds to previous research: the Neck Disability Index seems to be a useful instrument for classifying whiplash subjects into subgroups. In general, we found that the group with moderate/severe disability reported high frequency of symptoms, high depression and post-traumatic stress scores and low level of life satisfaction. However, the recovered group also reported symptoms and post-traumatic stress scores, but these levels were not related to disability.

From: Work. 2010;35(3):369-94

The literature relevant to the treatment of Whiplash Associated Disorders is extensive and heterogeneous. A Participatory Action Research approach was used to engage a chiropractic community of practice and stakeholders in a systematic review to address a general question: ‘Does chiropractic management of whiplash associated disorders clients have an effect on improving health status?’ A systematic review of the empirical studies relevant to whiplash associated disorders interventions was conducted followed by a review of the evidence.

The initial search identified 1,155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of whiplash associated disorders intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with whiplash associated disorders is reported. Further review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: the whiplash associated disorders-plus model.

There is a baseline of evidence that suggests chiropractic care improves cervical range of motion and pain in the management of whiplash associated disorders. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The whiplash associated disorders-plus model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, subacute and chronic pain due to whiplash associated disorders. Furthermore, the whiplash associated disorders-plus model can be used in the future study of interventions and outcomes to advance evidence-based care in the management of whiplash associated disorders.

From: Pain. 2010 Jun 29. [Epub ahead of print]

Widespread sensory hypersensitivity is present in acute whiplash and is associated with poor recovery. Decreased nociceptive flexion reflex thresholds (spinal cord hyperexcitability) are a feature of chronic whiplash but have not been investigated in the acute to chronic injury stage. This study compared the temporal development of sensory hypersensitivity and nociceptive flexion reflex responses from soon after injury to either recovery or to transition to chronicity. It also aimed to identify predictors of persistent spinal cord hyperexcitability. Pressure and cold pain thresholds, nociceptive flexion reflex responses (threshold and pain VAS) were prospectively measured in 62 participants at <3 weeks, 3 and 6 months post whiplash injury and in 22 healthy controls on two occasions a month apart. Pain levels and psychological distress (GHQ-28; IES) were measured at baseline. Whiplash participants were classified at 6 months post-injury using the Neck Disability Index: recovered (8%), mild pain and disability (10-28%) or moderate/severe pain and disability (30%).

All whiplash groups demonstrated spinal cord hyperexcitability (lowered nociceptive flexion reflex thresholds) at 3 weeks post-injury. This hyperexcitability persisted in those with moderate/severe symptoms at 6 months but resolved in those who recovered or reported lesser symptoms at 6 months. In contrast generalized sensory hypersensitivity (pressure and cold) was only ever present in those with persistent moderate/severe symptoms and remained unchanged throughout the study period. This suggests different mechanisms underlie sensory hypersensitivity and nociceptive flexion reflex responses. In multivariate analyses only initial Neck Disability Index scores were a unique predictor of persistent spinal cord hyperexcitability indicating possible ongoing peripheral nociception following whiplash injury.

Related citations

In Pain. 2003 Aug;104(3):509-17. Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. The conclusion states, “These findings suggest that those with persistent moderate/severe symptoms at 6 months display, soon after injury, generalised hypersensitivity suggestive of changes in central pain processing mechanisms. This phenomenon did not occur in those who recover or those with persistent mild symptoms.”

In Clin J Pain. 2008 Feb;24(2):124-30. Psychologic factors are related to some sensory pain thresholds but not nociceptive flexion reflex threshold in chronic whiplash. The discussion states, “We have demonstrated that psychologic factors have some association with sensory hypersensitivity (cold pain threshold measures) in chronic whiplash but do not seem to influence spinal cord excitability. This suggests that psychologic disorders are important, but not the only, determinants of central hypersensitivity in whiplash patients.”

In Phys Med Rehabil Clin N Am. 2006 May;17(2):287-302. Central hypersensitivity in chronic pain: mechanisms and clinical implications. It is stated, “Treatment strategies for central hypersensitivity in patients have been investigated mostly in neuropathic pain states. Possible therapy modalities for central hypersensitivity in chronic pain of musculoskeletal origin are largely unexplored. The limited evidence available and everyday practice show, at best, modest efficacy of the available treatment modalities for central hypersensitivity. The gap between basic knowledge and clinical benefits remains large and should stimulate further intensive research.”

In BMC Musculoskelet Disord. 2010 Feb 9;11:29. Minimizing the source of nociception and its concurrent effect on sensory hypersensitivity: an exploratory study in chronic whiplash patients. It was concluded, the patients with chronic whiplash associated disorders showed evidence of widespread sensory hypersensitivity to mechanical and thermal stimuli. The whiplash associated disorders group revealed decreased sensory hypersensitivity following a decrease in their primary source of pain stemming from the cervical zygapophyseal joints.

From: Man Ther. 2010 Aug;15(4):334-54

Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk and standardized mean differences were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias. Low quality evidence suggests clinically important long-term improvements in pain, function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment. High quality evidence suggests greater short-term pain relief than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache. Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

The following appear in Ugeskr Laeger. 2010 Jun 14 Articles in Danish

Predictors of chronic sequelae in whiplash trauma. 2010 Jun 14;172(24):1821-1824.

Prognostic factors for chronic whiplash associated disorder are identified. In whiplash associated disorder grade I-III, 50% report neck pain after one year (30% in background population). There is a female preponderance among WAD cases. 10% develop a work disability, but no gender differences are found. Age, crash issues, magnetic resonance imaging of the neck and smooth pursuit neck torsion test are of no prognostic value. While reduced active neck mobility is associated with a 4.6 times raised risk for work disability after one year, the impact-of-event score yielded an increase in OR of 3.3, and intense pre-injury distress was associated with a 2.1 OR for pain after one year and a 2.8 OR for work disability. Intense headache/neck pain and a multitude of non-painful complaints were both associated with a 3.5 to 4.0 times raised risk of work disability after a year.

Treatment of whiplash associated disorders. 2010 Jun 14;172(24):1818-1820.

Treatment of whiplash associated disorders starts with a thorough clinical examination, which may be repeated after 1-3 weeks. For optimal results it is essential that the patient receives clear information about the condition and that any pain is treated effectively with analgesics. Risk factors for persistent symptoms can often be identified early and should be addressed adequately. If symptoms persist and conservative treatments are chosen, these should be active and they should focus on sustaining or regaining usual activities.

Social, economic and cultural aspects of whiplash syndrome. 2010 Jun 14;172(24):1815-1817.

The sequelae following whiplash injuries entail considerable human costs and expenses for both treatment and social services, especially public income benefits. Frequently, many players are involved after whiplash injuries and good intersectional collaboration is therefore essential to counter the whilplash injuries patients’ tendency not to return to their jobs. There is a need for further research i) to identify evidence-based prophylaxis and treatment, ii) to monitor medical diagnoses in relation to social benefits to support research opportunities and iii) to assess whether other social solutions comprise alternatives superior to current treatment and compensation options.

Definition, classification and emidemiology of whiplash. 2010 Jun 14;172(24):1812-1814.

A whiplash trauma is caused by an acceleration-deceleration force transferring its energy to the cervical spine. Whiplash associated disorder refers to the symptoms that develop after a whiplash injury. The prognosis is favorable with recovery in over 90% of the injured subjects. In a fraction of patients, long-term symptoms with pain and cognitive and emotional symptoms may occur, causing long term disability. The pathophysiology is unclear. Most research groups favor a multifactorial pathophysiology similar to that observed for other chronic pain conditions without a clear nociceptive or neuropathic component.

From: Spine (Phila Pa 1976). 2010 Jun 8. [Epub ahead of print]

This was a cross-sectional study of population based traffic cohort to determine which factors are associated with both positive and negative expectations for returning to work after vehicle collision resulting in neck pain. Positive expectations predict better outcomes for a variety of health conditions, including return to work from soft-tissue injury (including whiplash associated disorders. However, we know little about those with negative expectations who may be at risk for poor whiplash associated disorder outcomes.

The authors assessed expectations for return to work in a population-based cohort of 2335 individuals with traffic related whiplash associated disorder. They used logistic regression analysis to model factors associated with expecting to return to work (compared with not expecting to return to work or being unsure).

Depressive symptomatology, lower education, lower income, male sex, and greater initial pain (greater percentage of body in pain and greater intensity of neck pain) were associated with lower return to work expectation. A number of demographic, socioeconomic, and injury-related factors were associated with expectations for return to work in whiplash associated disorder. Two of the strongest associated factors were depressive symptomatology and postcollision initial neck pain intensity. These results support using a biopsychosocial approach to evaluate expectancies and their influence on important health outcomes.

This confirms an earlier study in J Rehabil Med. 2010 Jan;42(1):66-73. Factors associated with recovery expectations following vehicle collision: a population-based study. It was concluded, “A number of demographic, socioeconomic and injury-related factors were associated with expectations for recovery in whiplash associated disorders. Two of the strongest associated factors were depressive symptomatology and initial neck pain intensity. These results support using a biopsychosocial approach to evaluate expectancies and their influence on important health outcomes.” This study found depressive symptomatology, lower education, lower income, male gender, younger age, being a passenger in the vehicle, history of neck pain, and greater initial pain (greater percentage of body in pain, greater intensity of neck pain and presence of low back and/or headache pain) were associated with poor expectations for recovery.

From: Disabil Rehabil. 2010 Jun 7. [Epub ahead of print]

The aim is to study how pain coping strategies and catastrophising are related to disability and depression in patients with whiplash associated disorders. Specifically, the authors wanted to test if they are independent predictive variables, after controlling for pain severity, sociodemographic and crash-related variables.

A convenience sample of 147 patients with whiplash associated disorders of less than 3 months of duration was recruited. They were requested to complete the Pain Catastrophising Scale, the two-item version of the Chronic Pain Coping Inventory and to report sociodemographic and crash-related information, pain intensity, disability and depression.

Although several pain coping strategies were related with disability in univariate analyses, only asking for assistance was a marginally significant predictive variable in a multiple regression analysis after controlling for catastrophising. Catastrophising was a significant predictive variable after controlling for pain coping strategies. With depression as the outcome, resting and task persistence were the only pain coping strategies which were related in univariate analyses. However, none of them were predictive variables after controlling for catastrophising. Again, catastrophising was a significant predictive variable after controlling for pain coping strategies.

The results show that catastrophising about pain is more important than pain coping strategies in patients with whiplash associated disorders of a short duration. These results can contribute to the conceptual distinction between pain coping strategies and catastrophising.

Source: The Pain Catastrophizing Scale Development and Validation