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Fear and Neck Pain after Car Crashes

Posted on: 05/12/2004
Many people in car crashes develop neck pain. For most of them, it goes away. For some, it causes chronic pain and disability. It is very hard for doctors to know which patients are going to get better and which aren't. If doctors could predict which patients were most likely to have chronic pain, they could take steps to help prevent long-lasting problems.

These researchers are working on finding ways to predict who will have chronic neck disability. They tested 82 people with neck pain one week after they were in a car crash. They did the same tests again 24 weeks later. Muscle action was checked. Patients answered questions about their pain, function, and fears of movement and injury. They were also asked questions to find out if they were catastrophizing, which means viewing the injury in the most negative way possible.

The tests focused on identifying patients who were afraid to move their necks normally. This is because such fear avoidance beliefs have been shown to get in the way of recovery for patients with other types of spine injuries. Many studies show that fear avoidance beliefs in patients with low back pain can interfere with healing.

The neck patients in this study were divided into two groups. About two-thirds recovered within the 24 weeks. The other one-third was categorized as having chronic neck pain and disability. When the researchers looked at the data, they found a few test results that seemed linked to developing chronic neck problems. The patients who showed a high rate of neck disability on the standard survey were more likely to develop chronic problems. When those results were combined with a high rate of fear avoidance beliefs, the data could predict about 80 percent of the patients who would develop chronic neck problems. Muscle testing was the least useful test for predicting chronic neck problems.

This type of data can help doctors and therapists know what types of tests are reliable. It also helps them know what kinds of survey answers to look for in their patients with neck pain. If patients with serious neck pain and fear avoidance beliefs could be identified early on, treatments could be recommended to help them overcome their fears of movement and activity.

Marc J. Nederhand, MD, PhD, et al. Predictive Value of Fear Avoidance in Developing Chronic Neck Pain Disability: Consequences for Clinical Decision Making. In Archives of Physical Medicine and Rehabilitation. March 2004. Vol. 85. No. 3. Pp. 496-501.

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