PREVENTING CHRONIC WHIPLASH PAIN: BIOBEHAVIORAL APPROACH

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Applicant's Description: Over 1.8 million people in the US 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. Although little is known about what predicts chronicity of whiplash-associated disorders (WADs), research on chronic musculoskeletal pain following injury suggests that initial emotional reactivity, particularly fears of reinjury and avoidance of activity, contributes significantly to chronicity of pain and disability. Based on this model, early interventions to reduce avoidance and inactivity have been shown to prevent chronic pain following back injury. This is the first study to evaluate interventions with WAD sufferers within 3 months of an MVA. The interventions are integrated biobehavioral approaches based on an anxiety-reduction model consisting of information, relaxation training, and imaginable and actual exposure to feared physical activities. The primary purpose of this application is to conduct a clinical trial testing interventions to prevent chronic WAD pain and disability. The study will also delineate factors associated with the development of chronic symptoms and disability following initial WADs within a diathesis-stress model. Three hundred (225 symptomatic, 75 asymptomatic) post MVA, whiplash victims will be included. Symptomatic subjects will receive one of 3 treatment conditions: (1) standard care + an information booklet; (2) 3 didactic sessions with a physician, psychologist and physical therapist (PT) providing information regarding WAD and exercise, or (3) 3 treatment sessions with a physician, psychologist and PT that includes physical exercise, relaxation training, and exposure-based strategies to reduce anxiety associated with physical activity. We will evaluate the efficacy of these treatments using pain, physical, behavioral, cognitive, and affective outcomes at the post-treatment and 6-month follow-up. Additionally, we will examine the presence and degree of known risk factors, both accident-related and prepositional variable (e.g., negative affectivity) for the persistence of the WAD symptoms following MVAs. The data from this trial will provide important information about the potential of early interventions to prevent chronic problems that afflict millions of MVA victims.