TREATMENTS FOR WHIPLASH-ASSOCIATED DISORDERS (WAD) - BIOBEHAVIORAL APPROACH

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。2000年，美国发生了超过610万起警方报告的机动车事故。鞭击损伤是由MVA引起的最常见的损伤形式。容易产生负面情绪反应的人有经历更高水平的恐惧和焦虑的风险，因此可能容易患上鞭打相关疾病(WADS)，这是鞭打损伤的临床表现。慢性赘肉(持续6个月以上的)对治疗具有极强的抵抗力。由于MVA后相对轻微的颈部损伤，对慢性WAD的病理生理学知之甚少。在背痛人群中进行早期干预，以减少恐惧和随后避免活动为目标，已被证明可以预防慢性肌肉骨骼疼痛和残疾。然而，使用类似的干预措施预防WAD的慢性化还没有被探索过。这项临床试验的目的是测试早期生物行为干预的有效性，以防止MVA术后与鞭打损伤相关的慢性疼痛和残疾。与标准护理相比，这项研究比较了两种干预措施在亚急性阶段减少疼痛和残疾方面的效果，从而防止WAD症状的维持。我们假设：(1)与标准护理对象相比，干预对象的焦虑、疼痛和功能限制的减少程度将显著更大；(2)基于暴露的焦虑减少干预将比使用教育讲座的干预方法产生显著更好的结果；(3)与症状在MVA后1个月内缓解的对象相比，亚急性WADS对象报告的焦虑和恐惧回避程度显著更高。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Over 6.1 million police-reported motor vehicle accidents (MVAs) occurred in the United States in 2000. Whiplash injury is the most common form of injury resulting from an MVA. People prone to negative emotional responses are at risk of experiencing elevated levels of fear and anxiety and consequently may be predisposed to develop Whiplash-Associated Disorders (WADs), the clinical manifestations of whiplash injury. Chronic WADs (those that last longer than 6 months) are extremely resistant to treatment. Little is known about the pathophysiology of chronic WADs due to relatively minor neck injury following MVAs. Early interventions in back pain populations that target reduction of fear and subsequent avoidance of activity have been shown to prevent chronic musculoskeletal pain and disability. Preventing chronicity of WADs using similar interventions, however, has not been explored. The purpose of this clinical trial is to test the efficacy of early, biobehavioral interventions to prevent chronic pain and disability associated with whiplash injuries following an MVA. The study compares the efficacy of two interventions in reducing pain and disability at the subacute stage, thus preventing maintenance of WAD symptoms compared to standard care. We hypothesize that (1) intervention subjects will demonstrate significantly greater reduction of anxiety, pain, and functional limitations than standard care subjects, (2) an intervention using exposure-based anxiety reduction will result in significantly better outcomes than an intervention using educational lectures, and (3) subacute WADs subjects will report significantly greater degrees of anxiety and fear-avoidance than subjects whose symptoms remit within 1 month following the MVA.