Reciprocal associations of pain and post-traumatic stress symptoms after whiplash injury: A longitudinal, cross-lagged study

Sophie Lykkegaard Ravn*, Michele Sterling, Yael Lahav, Tonny Elmose Andersen

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background: The objectives of the current study were to investigate (1) the longitudinal, reciprocal associations between pain and post-traumatic stress symptoms as proposed by the mutual maintenance model, and (2) to assess the predictive value of the three clusters of post-traumatic stress, where the model revealed that post-traumatic stress symptoms maintained pain in a consecutive cohort of whiplash-injured. Methods: Participants (n = 253; 66.4% women) were people with WAD grades I–III following motor vehicle crashes in Australia. Pain and post-traumatic stress symptoms were assessed by questionnaires over the course of a year (at baseline (<4 weeks), 3, 6 and 12 months post-injury). The objectives were tested using auto-regressive cross-lagged modelling and two additional structural equation models. Results: The analyses revealed that post-traumatic stress symptoms at baseline predicted an increase in pain between baseline and 3 months and that post-traumatic stress symptoms at 6 months predicted an increase in pain between 6 and 12 months, beyond the stability of pain over time. Furthermore, hyperarousal at baseline significantly predicted pain at 3 months and hyperarousal at 6 months significantly predicted pain at 12 months with 16 and 23% explained variance, respectively. [Correction added on 2 March 2018 after first online publication: the explained variance for hyperarousal symptoms at 6 months was previously given incorrectly and has been corrected to 23% in this version.]. Conclusions: The results point to a temporal main effect of post-traumatic stress symptoms on pain over and above the stability of pain itself within the first 3 months post-injury and again in the chronic phase from 6 to 12 months with hyperarousal symptoms driving these effects. From 3 to 6 months, there was a slip in the maintenance patterns with no cross-lagged effects. Significance: Investigating mutual maintenance of pain and PTSS in whiplash, the present study found evidence suggesting a maintaining effect of PTSS on pain within the first 3 months post-injury and from 6 to 12 months driven by hyperarousal, highlighting the importance of addressing PTSS.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Pain
Vol/bind22
Udgave nummer5
Sider (fra-til)926-934
ISSN1090-3801
DOI
StatusUdgivet - maj 2018

Fingeraftryk

Whiplash Injuries
Maintenance
Wounds and Injuries
Motor Vehicles
Publications

Citer dette

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title = "Reciprocal associations of pain and post-traumatic stress symptoms after whiplash injury: A longitudinal, cross-lagged study",
abstract = "Background: The objectives of the current study were to investigate (1) the longitudinal, reciprocal associations between pain and post-traumatic stress symptoms as proposed by the mutual maintenance model, and (2) to assess the predictive value of the three clusters of post-traumatic stress, where the model revealed that post-traumatic stress symptoms maintained pain in a consecutive cohort of whiplash-injured. Methods: Participants (n = 253; 66.4{\%} women) were people with WAD grades I–III following motor vehicle crashes in Australia. Pain and post-traumatic stress symptoms were assessed by questionnaires over the course of a year (at baseline (<4 weeks), 3, 6 and 12 months post-injury). The objectives were tested using auto-regressive cross-lagged modelling and two additional structural equation models. Results: The analyses revealed that post-traumatic stress symptoms at baseline predicted an increase in pain between baseline and 3 months and that post-traumatic stress symptoms at 6 months predicted an increase in pain between 6 and 12 months, beyond the stability of pain over time. Furthermore, hyperarousal at baseline significantly predicted pain at 3 months and hyperarousal at 6 months significantly predicted pain at 12 months with 16 and 23{\%} explained variance, respectively. [Correction added on 2 March 2018 after first online publication: the explained variance for hyperarousal symptoms at 6 months was previously given incorrectly and has been corrected to 23{\%} in this version.]. Conclusions: The results point to a temporal main effect of post-traumatic stress symptoms on pain over and above the stability of pain itself within the first 3 months post-injury and again in the chronic phase from 6 to 12 months with hyperarousal symptoms driving these effects. From 3 to 6 months, there was a slip in the maintenance patterns with no cross-lagged effects. Significance: Investigating mutual maintenance of pain and PTSS in whiplash, the present study found evidence suggesting a maintaining effect of PTSS on pain within the first 3 months post-injury and from 6 to 12 months driven by hyperarousal, highlighting the importance of addressing PTSS.",
author = "Ravn, {Sophie Lykkegaard} and Michele Sterling and Yael Lahav and Andersen, {Tonny Elmose}",
note = "{\circledC} 2018 European Pain Federation - EFIC{\circledR}.",
year = "2018",
month = "5",
doi = "10.1002/ejp.1178",
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pages = "926--934",
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issn = "1090-3801",
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Reciprocal associations of pain and post-traumatic stress symptoms after whiplash injury : A longitudinal, cross-lagged study. / Ravn, Sophie Lykkegaard; Sterling, Michele; Lahav, Yael; Andersen, Tonny Elmose.

I: European Journal of Pain, Bind 22, Nr. 5, 05.2018, s. 926-934.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Reciprocal associations of pain and post-traumatic stress symptoms after whiplash injury

T2 - A longitudinal, cross-lagged study

AU - Ravn, Sophie Lykkegaard

AU - Sterling, Michele

AU - Lahav, Yael

AU - Andersen, Tonny Elmose

N1 - © 2018 European Pain Federation - EFIC®.

PY - 2018/5

Y1 - 2018/5

N2 - Background: The objectives of the current study were to investigate (1) the longitudinal, reciprocal associations between pain and post-traumatic stress symptoms as proposed by the mutual maintenance model, and (2) to assess the predictive value of the three clusters of post-traumatic stress, where the model revealed that post-traumatic stress symptoms maintained pain in a consecutive cohort of whiplash-injured. Methods: Participants (n = 253; 66.4% women) were people with WAD grades I–III following motor vehicle crashes in Australia. Pain and post-traumatic stress symptoms were assessed by questionnaires over the course of a year (at baseline (<4 weeks), 3, 6 and 12 months post-injury). The objectives were tested using auto-regressive cross-lagged modelling and two additional structural equation models. Results: The analyses revealed that post-traumatic stress symptoms at baseline predicted an increase in pain between baseline and 3 months and that post-traumatic stress symptoms at 6 months predicted an increase in pain between 6 and 12 months, beyond the stability of pain over time. Furthermore, hyperarousal at baseline significantly predicted pain at 3 months and hyperarousal at 6 months significantly predicted pain at 12 months with 16 and 23% explained variance, respectively. [Correction added on 2 March 2018 after first online publication: the explained variance for hyperarousal symptoms at 6 months was previously given incorrectly and has been corrected to 23% in this version.]. Conclusions: The results point to a temporal main effect of post-traumatic stress symptoms on pain over and above the stability of pain itself within the first 3 months post-injury and again in the chronic phase from 6 to 12 months with hyperarousal symptoms driving these effects. From 3 to 6 months, there was a slip in the maintenance patterns with no cross-lagged effects. Significance: Investigating mutual maintenance of pain and PTSS in whiplash, the present study found evidence suggesting a maintaining effect of PTSS on pain within the first 3 months post-injury and from 6 to 12 months driven by hyperarousal, highlighting the importance of addressing PTSS.

AB - Background: The objectives of the current study were to investigate (1) the longitudinal, reciprocal associations between pain and post-traumatic stress symptoms as proposed by the mutual maintenance model, and (2) to assess the predictive value of the three clusters of post-traumatic stress, where the model revealed that post-traumatic stress symptoms maintained pain in a consecutive cohort of whiplash-injured. Methods: Participants (n = 253; 66.4% women) were people with WAD grades I–III following motor vehicle crashes in Australia. Pain and post-traumatic stress symptoms were assessed by questionnaires over the course of a year (at baseline (<4 weeks), 3, 6 and 12 months post-injury). The objectives were tested using auto-regressive cross-lagged modelling and two additional structural equation models. Results: The analyses revealed that post-traumatic stress symptoms at baseline predicted an increase in pain between baseline and 3 months and that post-traumatic stress symptoms at 6 months predicted an increase in pain between 6 and 12 months, beyond the stability of pain over time. Furthermore, hyperarousal at baseline significantly predicted pain at 3 months and hyperarousal at 6 months significantly predicted pain at 12 months with 16 and 23% explained variance, respectively. [Correction added on 2 March 2018 after first online publication: the explained variance for hyperarousal symptoms at 6 months was previously given incorrectly and has been corrected to 23% in this version.]. Conclusions: The results point to a temporal main effect of post-traumatic stress symptoms on pain over and above the stability of pain itself within the first 3 months post-injury and again in the chronic phase from 6 to 12 months with hyperarousal symptoms driving these effects. From 3 to 6 months, there was a slip in the maintenance patterns with no cross-lagged effects. Significance: Investigating mutual maintenance of pain and PTSS in whiplash, the present study found evidence suggesting a maintaining effect of PTSS on pain within the first 3 months post-injury and from 6 to 12 months driven by hyperarousal, highlighting the importance of addressing PTSS.

U2 - 10.1002/ejp.1178

DO - 10.1002/ejp.1178

M3 - Journal article

C2 - 29377453

VL - 22

SP - 926

EP - 934

JO - European Journal of Pain

JF - European Journal of Pain

SN - 1090-3801

IS - 5

ER -