PTSD Linked With Persistent Neck Pain, Disability Among Vehicle Crash Survivors

A recent study from Australia found that the presence of post-traumatic stress disorder (PTSD) symptoms was associated with an increased risk of persisting neck pain and disability in motor vehicle crash (MVC) survivors with whiplash injuries.

However, the findings are mixed as to which PTSD symptom(s) best predicts recovery. Only the hyperarousal/numbing symptom cluster predicted long-term neck pain—related disability, and the authors wrote that the finding could have implications for the diagnosis, assessment, and management of the psychological impact of whiplash-injured individuals following a crash.

The study appeared in a recent issue of Pain Reports.

About 25% of those with whiplash following a crash meet the diagnostic criteria for PTSD. PTSD is marked by a constellation of symptoms that can arise after a traumatic event.

PTSD is made up of 3 symptom clusters: re-experiencing, avoidance, and hyperarousal. Previous studies have shown an association between the presence of PTSD symptoms and the persistence of whiplash symptoms.

Several studies have shown that PTSD symptoms are predictive of later chronic neck pain and disability following a whiplash injury. Whiplash-injured individuals who experience moderate to severe pain and disability at 6 to 12 months post injury are also more likely to report more severe PTSD symptoms.

Consequently, several studies have attempted to identify the PTSD-symptom clusters likely to predict poor recovery in this population, but results have been mixed. This study sought to:

• Assess the structural model of PTSD-symptom clusters using a sample of nonhospitalized whiplash-injured individuals who presented with a range of PTSD symptoms following a MVC
• Identify the symptom clusters that best predict long-term neck pain—related disability

Whiplash-injured individuals (n =146) completed the Neck Pain Disability Index (NDI) and the Post-traumatic Stress Diagnostic Scale (PDS) at baseline (<1 month) and at 6 months follow-up.

Principal component analyses generated 2 symptom clusters: re-experiencing/avoidance and hyperarousal/numbing.

Nine trauma-related PTSD symptoms loaded exclusively on the re-experiencing/avoidance cluster and 7 nonspecific PTSD symptoms loaded exclusively on the hyperarousal/numbing cluster.

One PTSD symptom (ie, inability to recall an important aspect of the trauma) had no significant loading on either clusters.

Structural equation modelling analysis indicated that there was a significant positive relationship between the hyperarousal/numbing symptom cluster and long-term neck pain-related disability.

No significant relationship was found between the re-experiencing/avoidance symptom cluster and long-term neck pain-related disability.

Individuals who do not think of their MVC as being a traumatic event but still have a range of nonspecific PTSD symptoms may not benefit from a psychological trauma intervention (ie, exposure therapy). However, they may benefit from self-management techniques to help them develop their skills and confidence in managing their recovery.

Reference

Maujean A, Gullo MJ, Andersen TE, et al. Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability. Pain Rep. 2017;2(6):e631-e637. doi: 10.1097/PR9.0000000000000631.