Preventing Chronic Whiplash Pain
Condition: Whiplash Injuries
MeSH terms: Whiplash Injuries
Study type: Interventional
Phase: Phase 3

Summary: 
      This study is aimed at developing ways to prevent acute pain from becoming chronic
      pain--specifically, pain associated with whiplash-associated disorders (WADs) from motor
      vehicle accidents. Research on the development of chronic pain due to musculoskeletal injury
      suggests that a person's initial emotional reactions, particularly fear of reinjury and
      subsequent avoidance of activity, contribute significantly to chronic pain and persistent
      disability. This study will treat people with WADs during the first three months after a
      motor vehicle accident with a behavioral and physical exercise program designed to encourage
      activity and discourage continued fear of movement, pain, and disability. The study will
      compare the effectiveness of two anxiety-reduction treatments to standard care in reducing
      pain and activity limitations in people with WADs in the 2 to 3 months after motor vehicle
      accidents.
    

Detailed description: 
      More than 1.8 million people in the United States suffer from chronic pain and disability
      following motor vehicle accidents (MVAs) each year. The majority of these cases start with a
      relatively minor neck injury. The Quebec Task Force Study on Whiplash Associated Disorders
      (WAD) was created in 1989 to determine the clinical, public health, social, and financial
      determinants of WAD. Multiple studies have described the clinical features of WAD, which
      include neck, shoulder, arm, low back, and head pain; tinnitus; visual symptoms; dizziness;
      temporomandibular joint pain; and paraesthesias. Onset of these symptoms after the injury is
      usually delayed for several hours and worsens within 24 to 48 hours. Neck pain is the most
      frequent symptom, and between 14% and 42% of patients with WAD develop chronic neck pain
      symptoms. Studies suggest that the neck pain will either resolve in the first few months or
      persist indefinitely. One variable that may predict outcome after an MVA is the acute
      emotional response immediately after the MVA.

      A severe emotional reaction accompanied by neck pain and stiffness after an MVA could lead an
      injured person to avoid subsequent physical activity through such mechanisms as fear
      avoidance and fear of reinjury. Research investigating the evolution of chronic pain due to
      musculoskeletal injury suggests that initial emotional reactivity, particularly fear of
      reinjury and subsequent activity avoidance, contributes significantly to unremitting pain and
      persistent disability. Research based on this model has shown that early interventions
      targeting normalization of excessive emotionality and restriction of activities associated
      with fear following injury effectively prevent chronic pain due to back injury. No previous
      study has sought to intervene during the first three months after an MVA with a behavioral
      and physical exercise program to encourage activity and discourage continued fear of
      movement, pain and disability.

      This study consists of two primary components: (1) To compare the effectiveness of two
      anxiety-reduction treatments with standard care in reducing pain and activity limitations in
      patients with WADs 2 to 3 months following MVAs. (2) To test whether psychological responses
      to the initial trauma, such as fear avoidance, fear of injury, and negative affectivity,
      discriminate between symptomatic WAD patients and WAD sufferers whose symptoms had resolved 2
      to 3 months post-MVA.
    

Intervention name(s): Behavioral treatments; Physical therapy
Intervention type(s): Behavioral; Behavioral
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single
Primary purpose: Prevention
Keywords: Whiplash; Chronic pain; Motor vehicle accidents