Psychologic Processes in Daily Life With Chronic Whiplash: Relations of Posttraumatic Stress Symptoms and Fear-of-pain to Hourly Pain and Uptime

Sterling, Michele and Chadwick, Benjamin J. (2010) Psychologic Processes in Daily Life With Chronic Whiplash: Relations of Posttraumatic Stress Symptoms and Fear-of-pain to Hourly Pain and Uptime. Clinical Journal of Pain, 26 7: 573-582. doi:10.1097/AJP.0b013e3181e5c25e


Author Sterling, Michele
Chadwick, Benjamin J.
Title Psychologic Processes in Daily Life With Chronic Whiplash: Relations of Posttraumatic Stress Symptoms and Fear-of-pain to Hourly Pain and Uptime
Journal name Clinical Journal of Pain   Check publisher's open access policy
ISSN 0749-8047
1536-5409
Publication date 2010-09
Sub-type Article (original research)
DOI 10.1097/AJP.0b013e3181e5c25e
Volume 26
Issue 7
Start page 573
End page 582
Total pages 10
Place of publication New York
Publisher Lippincott Williams and Wilkins
Collection year 2011
Language eng
Formatted abstract
Objectives: Recent models of the relationship between posttraumatic stress and whiplash pain suggest that psychological stress relating to a motor vehicle crash may influence pain perception. The mechanisms of this relationship may be through more direct, psychological pathways, or through factors proposed by the fear-avoidance models of chronic pain. This study sought to investigate the relative contribution of fear-of-pain and trauma symptomatology to daily pain and time spent in an upright posture (uptime) in chronic whiplash-associated disorder (WAD).

Methods:
Hourly electronic-diary reports were used to explore the within-day relationship of psychological trauma symptoms and fear-of-pain to same-hour and next-hour pain reports and next-hour uptime (measured by accelerometers) in 32 individuals with a chronic WAD. Within-person effects were analyzed for 329 diary entries using multilevel modeling with fixed slopes and random intercepts.

Results:
Reports of trauma-related hyperarousal were associated with greater same-hour pain, and this relationship was mediated by fear-of-pain. Fear-of-pain and uptime were independently associated with reports of increased next-hour pain (controlling for first-order serial autocorrelation). Fear-of-pain was unrelated to next-hour uptime, but trauma-related avoidance symptoms were associated with reduced uptime. This study supports the relationship between psychological trauma responses and pain, suggesting behavioral (avoidance) pathways and effects on pain perception through fear-of-pain. These findings reinforce the need to evaluate traumatic stress as a factor in recovery from WAD.  © 2010 Lippincott Williams & Wilkins, Inc
Keyword Whiplash associated disorders
Posttraumatic stress
Within-person analyses
Multilevel modeling
Coping strategies
Avoidance model
Momentary assessment
Mutual maintenance
Electronic diary
Persistent Pain
Disability
Disorders
Intensity
Unjury
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Health and Rehabilitation Sciences Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 17 times in Thomson Reuters Web of Science Article | Citations
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Created: Sun, 05 Sep 2010, 00:07:53 EST