Pain-related fear and attentional processes in the development of chronic disability in neck pain patients after a motor vehicle accident
01 / 2002 - 01 / 2007
Nederlandse Organisatie voor Wetenschappelijk Onderzoek (NWO)
Chronic neck pain is a common complaint in western society. In more than 90% of the cases, the condition is called non-specific because medical investigations fail to reveal a somatic origin. Neck pain complaints frequently follow motor vehicle accidents, and rear-end collisions in particular. In 20 to 30% of patients with neck complaints after an accident, daily functioning is limited and quality of life is heavily affected in terms of social participation and quality of life one year later. So far, there is a lack of evidence on prognostic factors, and a lack of information on the effectiveness of commonly used treatments. Existing prognostic studies have focused on the influence of accident-related variables, physical factors, premorbid stressors and personality characteristics and revealed little evidence on the predictive power of these variables. The recent literature suggests that future research should focus on improving quality and addressing new questions such as the mechanism, the developmental time factor, and the relevance that these risk factors have for intervention. In the area of musculoskeletal pain, one of the etiologic models that have received increased attention lately fear-avoidance model. This model postulates two opposing behavioral responses: confrontation and avoidance, and presents possible pathways by which injured patients get caught in a downward spiral of increasing avoidance, disability and pain. The model predicts that there are several ways in which pain-related fear can lead to disability, of which catastrophizing beliefs about pain, pain-related fear, hypervigilance to bodily signals and avoidance behaviors are central elements. The aim of the current study is to test whether the fear-avoidance model can successfully be used to predict chronic pain disability due to neck pain as a result of motor vehicle accidents. Because of the identifiable traumatic event, this group is particularly suitable for research on determinants of chronification. The study fits with theme 2b of the NWO Research Program PIJN2b: (Psychosocial determinants of chronification of pain in children, youngsters and adults). It is a test of the assumption that, by analogy with recent and compelling findings in non-specific back pain, pain catastrophizing and pain-related fear are the major determinants for the development of chronic disability and reduced quality of life due to neck pain after a motor vehicle accident. This project not only examines whether attentional processes (hypervigilance) mediate the association between pain-related fear and pain severity, it also tests the effectiveness of a tailored intervention for fearful and catastrophizing subjects with neck pain who are "at risk" for developing chronic disability and reduced quality of life.