The fear avoidance model (FAM) has been proposed to explain the development of chronic disability in a variety of conditions including whiplash associated disorders (WAD). The FAM does not account for symptoms of posttraumatic stress and sensory hypersensitivity which are associated with poor recovery from whiplash injury. The aim of this study was to explore a model for the maintenance of pain and related disability in people with WAD including symptoms of PTSD, sensory hypersensitivity and FAM components. The relationship between individual components in the model and disability and how these relationships changed over the first 12 weeks post-injury were investigated.We performed a longitudinal study of 103 (74 female) patients with WAD. Measures of pain intensity, cold and mechanical pain thresholds, symptoms of posttraumatic stress, pain catastrophising, kinesiophobia and fear of cervical spine movement were collected within 6 weeks of injury and at 12 weeks post injury. Mixed model analysis using Neck Disability Index (NDI) scores and average 24 hour pain intensity as the dependent variables revealed that overall model fit was greatest when measures of fear of movement, post-traumatic stress and sensory hypersensitivity were included. The interactive effects of time with catastrophising, and time with fear of activity of the cervical spine were also included in the best model for disability. These results provide preliminary support for the addition of neurobiological and stress system components to the FAM to explain poor outcome in patients with WAD.
AD - 1RECOVER Injury Research Centre, NHMRC Centre of research Excellence in Recovery after Road Traffic Injury, Menzies Health Institute Queensland, Griffith University 2The George Institute for Global Health, University of Sydney. AN - 27007066 BT - Pain DP - NLM ET - 2016/03/24 LA - Eng LB - AUSThe fear avoidance model (FAM) has been proposed to explain the development of chronic disability in a variety of conditions including whiplash associated disorders (WAD). The FAM does not account for symptoms of posttraumatic stress and sensory hypersensitivity which are associated with poor recovery from whiplash injury. The aim of this study was to explore a model for the maintenance of pain and related disability in people with WAD including symptoms of PTSD, sensory hypersensitivity and FAM components. The relationship between individual components in the model and disability and how these relationships changed over the first 12 weeks post-injury were investigated.We performed a longitudinal study of 103 (74 female) patients with WAD. Measures of pain intensity, cold and mechanical pain thresholds, symptoms of posttraumatic stress, pain catastrophising, kinesiophobia and fear of cervical spine movement were collected within 6 weeks of injury and at 12 weeks post injury. Mixed model analysis using Neck Disability Index (NDI) scores and average 24 hour pain intensity as the dependent variables revealed that overall model fit was greatest when measures of fear of movement, post-traumatic stress and sensory hypersensitivity were included. The interactive effects of time with catastrophising, and time with fear of activity of the cervical spine were also included in the best model for disability. These results provide preliminary support for the addition of neurobiological and stress system components to the FAM to explain poor outcome in patients with WAD.
PY - 2016 SN - 1872-6623 (Electronic)