A Randomized Controlled Trial of an Educational Intervention to Prevent the Chronic Pain of Whiplash Associated Disorders Following Rear-End Motor Vehicle Collisions

Brison, Robert J.; Hartling, Lisa; Dostaler, Suzanne M.; Leger, Andy; Rowe, Brian H.; Stiell, Ian G.; Pickett, William

doi:10.1097/01.brs.0000174115.58954.17

Cited by 65 publications

(33 citation statements)

References 13 publications

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“…35 In people with acute whiplash injury, one large randomized controlled study performed in 405 patients who presented to the emergency department found that an educational video added to usual care resulted in a 7.9% (95% confidence interval −2.0 to 17.8) decrease in the proportion of people who still had pain at 24 weeks compared with usual care alone. 36 Fig 1 | The biopsychosocial model of pain posits that biological, psychological, and social factors influence who develops chronic pain (pink circles) and that chronic pain has biological, psychological, and social consequences (blue circles 45 In an MRI study of 78 patients with cervical radiculopathy for less than one month, the clinically affected root was identified in 73% of patients. 46 However, the false positive rate was 45% and the false negative rate was about 26%, indicating the absence of compression at the affected level.…”

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confidence: 99%

Advances in the diagnosis and management of neck pain

Cohen

Hooten

2017

BMJ

234

182

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Neck pain imposes a considerable personal and socioeconomic burden-it is one of the top five chronic pain conditions in terms of prevalence and years lost to disability-yet it receives a fraction of the research funding given to low back pain. Although most acute episodes resolve spontaneously, more than a third of affected people still have low grade symptoms or recurrences more than one year later, with genetics and psychosocial factors being risk factors for persistence. Nearly half of people with chronic neck pain have mixed neuropathic-nociceptive symptoms or predominantly neuropathic symptoms. Few clinical trials are dedicated solely to neck pain. Muscle relaxants and non-steroidal anti-inflammatory drugs are effective for acute neck pain, and clinical practice is mostly guided by the results of studies performed for other chronic pain conditions. Among complementary and alternative treatments, the strongest evidence is for exercise, with weaker evidence supporting massage, acupuncture, yoga, and spinal manipulation in different contexts. For cervical radiculopathy and facet arthropathy, weak evidence supports epidural steroid injections and radiofrequency denervation, respectively. Surgery is more effective than conservative treatment in the short term but not in the long term for most of these patients, and clinical observation is a reasonable strategy before surgery.

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confidence: 99%

Advances in the diagnosis and management of neck pain

Cohen

Hooten

2017

BMJ

234

182

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“…Unfortunately, specific management strategies aimed at preventing the development of chronic pain remain speculative and have been mainly restricted to behavioral approaches. 12,31,130 However, recent evidence points to more favorable outcomes (reduction in pain and disability) when employing a multimodal physiotherapy program addressing the specific impairments compared to a self-management behavioral approach for chronic WAD. 58 The effects, however, are mitigated in the presence of abnormal sensory features known to have prognostic value (eg, cold hyperalgesia and widespread allodynia).…”

mentioning

confidence: 99%

Characterization of Acute and Chronic Whiplash-Associated Disorders

Elliott¹,

Noteboom²,

Flynn³

et al. 2009

J Orthop Sports Phys Ther

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“…Several studies suggest that this may be an important intervention for patients with elevated levels of catastrophizing [8,17,42,43]. Reassurance and activity encouragement is another brief intervention [42,44], which has been shown to reduce a number of variables associated with catastrophizing, including pain intensity, pain-related fear, and disability [45][46][47]. Moseley et al have found significant reductions on catastrophizing following a single neurophysiological educational session [10].…”

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confidence: 99%

Changes in Pain Catastrophizing Following Physical Therapy for Musculoskeletal Injury: The Influence of Depressive and Post-traumatic Stress Symptoms

et al. 2013

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Purpose: The aim of the present study was to investigate the factors that influence the change in pain catastrophizing during the course of a physical therapy intervention for musculoskeletal injury. Methods: 187 clients enrolled in a 7-week physical therapy intervention were divided into four mutually exclusive groups on the basis of a pre-treatment assessment: (1) clients whose pretreatment catastrophizing scores and measures of mental health problems were below clinical threshold, (2) clients whose pre-treatment catastrophizing scores were above clinical threshold but who scores on measures of mental health problems were below clinical threshold, (3) clients whose pre-treatment catastrophizing scores were above clinical threshold and whose scores on measures of mental health problems were also above clinical threshold, and (4) clients whose pre-treatment catastrophizing scores were below clinical threshold but whose scores on measures of mental health problems were above clinical threshold. Results: The most prevalent risk profile consisted of clients with high levels of pain catastrophizing and high mental health problems (37 %), followed by the low catastrophizing and low mental health problems profile (35 %), the high catastrophizing and low mental health problems profile (16 %), and low catastrophizing and high mental health problems profile (10 %). Clients were considered nonresponders if their post-treatment catastrophizing score remained above clinical threshold following treatment. Chi square analyses revealed a significantly higher proportion of non-responders in the high catastrophizing and mental health problem group than in any other group. Conclusions: The presence of mental health symptoms markedly reduces the effectiveness of physical therapy for reducing catastrophizing scores. The 'risk value' of high catastrophizing scores thus appears to vary as a function of the presence or absence of mental health symptoms. The findings argue for the inclusion of measures of mental health problems in the routine screening of individuals treated in physical therapy.

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A Randomized Controlled Trial of an Educational Intervention to Prevent the Chronic Pain of Whiplash Associated Disorders Following Rear-End Motor Vehicle Collisions

Abstract: The presence of persistent WAD symptoms following simple rear-end MVCs was high in this sample. The video group demonstrated a trend toward less severe WAD symptoms. We recommend evaluating other educational interventions that could reduce WAD symptoms.

Cited by 65 publications

References 13 publications

Advances in the diagnosis and management of neck pain

Advances in the diagnosis and management of neck pain

Characterization of Acute and Chronic Whiplash-Associated Disorders

Changes in Pain Catastrophizing Following Physical Therapy for Musculoskeletal Injury: The Influence of Depressive and Post-traumatic Stress Symptoms

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