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Mental health status predicts long-term neck pain best after accidents

PainSci » bibliography » Atherton et al 2006
Tags: etiology, prog, neck, back pain, mind, pro, head/neck, spine, pain problems

Three pages on PainSci cite Atherton 2006: 1. The Complete Guide to Neck Pain & Cricks2. A Rational Guide to Fibromyalgia

PainSci commentary on Atherton 2006: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

480 people with neck pain after car accidents completed questionnaires three times in the year after their accident, and 128 (27%) of them reported neck pain each time. Of course, those chronic cases were also the injuries that were the worst to begin with. But those people also reported dramatically more pre-accident vulnerability, like psychological stress and other kinds of pain. In fact, people who went into the accident in poor shape were five times more likely to have chronic pain.

Very few details of the accident correlated with pain chronicity, and those that did were notably minor risk factors compared to psychological stress and a history of body pain.

“The greatest predictors of persistent neck pain … relate to psychological distress and aspects of pre-collision health rather than to various attributes of the collision itself.” For more detail about this research, see A Recipe for Chronic Neck Pain After Whiplash.

The findings are generally confirmed by other research, e.g. Carstensen.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To establish the aetiological influences of persistent neck pain following a motor vehicle collision and to construct a model for use in the emergency department for identifying patients at high risk of persistent symptoms.

DESIGN: Prospective cohort study. Patients recruited from hospital emergency departments were sent a questionnaire to gather information on various exposures. They were followed up at 1, 3, and 12 months to identify those with persistent symptoms.

MAIN OUTCOME MEASURE: Persistent neck pain (pain at 1, 3, and 12 months after collision).

RESULTS: The baseline survey included 765 patients. Subsequently, 480 completed a questionnaire at each follow up time point, of whom 128 (27%) reported neck pain on each occasion. Few collision specific factors predicted persistent neck pain. In contrast, a high level of general psychological distress, pre-collision history of widespread body pain, type of vehicle, whiplash associated symptoms, and initial neck disability best predicted the persistence of symptoms. Furthermore, these factors, in combination, accounted for more than a fivefold increase in the risk of persistent neck pain.

CONCLUSION: The greatest predictors of persistent neck pain following a motor vehicle collision relate to psychological distress and aspects of pre-collision health rather than to various attributes of the collision itself. With these factors, and those relating to initial injury severity, it is possible to identify a subgroup of patients presenting with neck pain with the highest risk of persistent symptoms. Thus, it is possible to identify whiplash patients with a poor prognosis and to provide closer follow up and specific attention to management in these individuals.

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