PREVENTING CHRONIC WHIPLASH PAIN: BIOBEHAVIORAL APPROACH

申请者描述：美国有超过180万人患有慢性病 每年发生机动车事故(MVA)后的疼痛和残疾。这个 这些病例中的大多数都是从相对轻微的颈部损伤开始。虽然 鲜为人知的是什么可以预测鞭打相关疾病的慢性化 (WADS)，关于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，对慢性疼痛和残疾有很大的贡献。基座 在这种模式下，减少回避和不活动的早期干预措施 证明可以预防背部受伤后的慢性疼痛。这是第一项研究 评估MVA术后3个月内对WAD患者的干预措施。这个 干预措施是综合的生物行为方法，基于 由信息、放松训练和训练组成的焦虑减轻模型 可以想象和实际接触到令人畏惧的身体活动。初级阶段 此应用程序的目的是进行临床试验测试 预防慢性疼痛和残疾的干预措施。这项研究还将 描述与慢性症状和发展相关的因素 在素质-压力模型中的最初WAD后的残疾。三 100名(225名有症状，75名无症状)MVA后，鞭打患者将 包括在内。有症状的受试者将接受3种治疗条件之一：(1) 标准护理+资料手册；(2)3次授课，有一名 医生、心理学家和物理治疗师(PT)提供信息 关于WAD和锻炼，或(3)与医生进行3次治疗， 心理学家和PT，包括体育锻炼、放松训练和 以暴露为基础的策略，以减少与体力活动相关的焦虑。 我们将评估这些治疗的疗效，包括疼痛、生理、 治疗后和6个月后的行为、认知和情感结果 后续行动。此外，我们还将检查已知风险的存在和程度 与事故相关的因素和前置变量(例如，负数 情感)对于MVA后WAD症状的持续性。数据 将提供有关早期治疗的可能性的重要信息 采取干预措施，防止困扰数百万MVA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.