Neck Solutions

The influence of fear of movement and pain catastrophizing on daily pain and disability in individuals with acute whiplash injury: A daily diary study

From: Pain. 2008 Jul 30; [Epub ahead of print]

Previous research supports the fear avoidance model in explaining the transition from acute to chronic non specific musculoskeletal pain. However, there is still little knowledge on when this vicious circle of pain, disability, pain catastrophizing and fear of movement starts. A daily diary study in 42 patients with acute whiplash injury was performed. Pain, disability, pain catastrophizing and fear of movement were measured on a daily basis with paper diaries for 21 consecutive days. Most participants showed a decline in pain and disability from day 1 to day 21 and this was paralleled by a decline in the fear of movement and pain catastrophizing in their whiplash injury. Multilevel analyses showed that both between and within persons, high levels of pain catastrophizing and fear of movement are associated with more pain and disability in whiplash. Moreover, the fear of movement was also predictive of pain and disability on the following day. We also examined the reverse association, that is, whether the changes in pain predict changes in the next day’s fear of movement and pain catastrophizing. Although for the fear of movement the model reached significance, the amount of explained variance was negligible in this whiplash study.

This study provides evidence that already in the early stages of whiplash related complaints, significant associations between fear of movement and pain intensity and disability occur, and that this association may be predictive of the persistence of pain.