PREVENTING CHRONIC WHIPLASH PAIN: BIOBEHAVIORAL APPROACH

申请人的描述：在美国，超过180万人患有慢性 每年发生的机动车事故（MVAs）。的 这些病例中的大多数开始于相对较小的颈部损伤。虽然 对于预测挥鞭样损伤相关疾病慢性化的因素知之甚少 （WAD），对损伤后慢性肌肉骨骼疼痛的研究表明， 最初的情绪反应，特别是害怕再次受伤和避免 活动，有助于显着慢性疼痛和残疾。基于 在这种模式下，早期干预，以减少回避和不活动， 可以预防背部受伤后的慢性疼痛。这是第一次研究 评估MVA后3个月内对WAD患者的干预措施。的 干预措施是综合的生物行为方法， 减少焦虑的模型，包括信息，放松训练， 想象和实际暴露于令人恐惧的身体活动。主 本申请的目的是进行临床试验测试 预防慢性WAD疼痛和残疾。该研究还将 描述与慢性症状发展相关的因素， 在素质压力模型中，初始WAD后的残疾。三 数百名（225名有症状，75名无症状）MVA后挥鞭样损伤受害者将 包括.症状受试者将接受3种治疗条件之一：（1） 标准护理+一本信息手册;（2）3次教学会议， 提供信息的医生、心理学家和理疗师 关于WAD和锻炼，或（3）3次与医生的治疗， 心理学家和PT，包括体育锻炼，放松训练， 基于安全的策略，以减少与体力活动相关的焦虑。 我们将通过疼痛、身体、 治疗后和6个月时的行为、认知和情感结局 随访此外，我们将检查已知风险的存在和程度 因素，包括与事故相关的和介词变量（例如，负 有效性）的持续性的WAD症状后MVA。数据 这项试验将提供有关早期 * 采取干预措施，预防困扰数百万制造业伤亡事故受害者的慢性问题。

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.