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5 Articles in this Series
Introduction
Cannabinoids Offer Some Hope for Oral Cancer Pain
Does Emotional Recovery After Accidents Influence Chronic Pain?
Fear of Movement and Pain Affect Post-ACL Reconstruction Recovery
High Prevalence of Falls Among Elderly in Pain
There’s an App for That—Mobile Technology Meets Pain Management

Does Emotional Recovery After Accidents Influence Chronic Pain?

The good news: the number of motor vehicle collisions (MVC) steadily decreased in the first decade of the millennium, from 13.4 million in 2000 to 10.9 million in 2009, according to statistics collected by the US Census Bureau.1 The number of people reporting injury also has declined, from over 2 million in 2000 to 1.5 million in 2009. 

The bad news: persistent pain and disability often accompany whiplash and other musculoskeletal injuries from accidents, most commonly rear-end collisions. Holm et al has found that poor expectations of recovery following motor vehicle accidents is a powerful predictor of adverse pain outcomes.2 However, the determinants of negative recovery expectations has not been thoroughly studied.
 
To study factors that may influence emotional recovery, a multicenter team of researchers headed by senior author Samuel McLean, MD, of the Department of Anesthesiology at the University of North Carolina, Chapel Hill, recruited 948 MVC victims who presented to 1 of 8 emergency departments within 24 hours of their accidents.3 Participants were asked to complete a survey that included questions about their pre-accident physical and mental health, initial post-MVC symptoms, the severity of the crash, whether they felt their life was in danger, and sense of fault of causing the accident. The participants also were asked to predict how long it would take them to recover both emotionally and physically from the trauma.
 
Participant recovery outcomes were determined by performing follow-up assessments at 6 weeks and 6 and 12 months. “Interestingly, expected time to emotional recovery, expected time to physical recovery, and certainty of recovery were only weakly associated,” said first author Jacqueline Nichols. “This suggests that recovery expectation are not global but specific to outcome type.”
 
The areas that were most predictive of poor pain outcomes included physical recovery expectations in the hours after MVC, whereas emotional recovery was most predictive of post-traumatic stress disorder outcomes (Table). "Acute psychological distress [intense peritraumatic distress, greater sense of life threat] was most strongly associated with poorer expected recovery, followed by the number of somatic symptoms in the emergency department [dizziness, nausea, ringing in ears], and traits of anxiety,” noted Ms. Nichols. In contrast, those that had better self-reported physical health before the accident and traits of optimism had shorter estimated time to emotional recovery. Other predictors of poorer outcomes included acute pain severity, older age, feeling the other driver was at fault, and incidence of pre-MVC pain and depressive symptoms.

 
The authors found that acute pain and psychological symptoms “are the dominant predictors of physical and emotional recovery.” These findings could lead to better psychological assessment and preventive interventions like counseling following MVC to reduce transition of acute pain into long-term disability. Further studies are needed to evaluate these findings.
 
References

1. United States Census Bureau. Motor vehicle accidents—number and deaths: 1990-2009. http://www.census.gov/compendia/statab/2012/tables/12s1103.pdf. May 26, 2014.

2.  Holm LW, Carroll LJ, Cassidy JD, Skillgate E, Ahlbom A. Widespread pain following whiplash-associated disorders: incidence, course, and risk factors. J Rheumatol. 2007;34(1):193-200.

3.  Nichols JW, Hu J, Soward A, et al. Not so great expectations: characteristics associated with negative expectations of physical and emotional recovery in the hours after motor vehicle collision. Poster presented at: American Pain Society 2014 Annual Meeting, Tampa, FL, April 30-May 3, 2014. Poster 238.

Next summary: Fear of Movement and Pain Affect Post-ACL Reconstruction Recovery
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