ACUTE EMOTIONAL RESPONSE TO COMMON WHIPLASH PREDICTS SUBSEQUENT PAIN COMPLAINTS - A PROSPECTIVE-STUDY OF 107 SUBJECTS SUSTAINING WHIPLASH INJURY

Previous studies claiming that psychosocial factors do not primarily i nfluence the course of recovery from common whiplash have all been con ducted on patient groups referred by medical physicians because of acu te symptoms days to weeks after the injury. These designs may falsely underestimate the role of psychosocial predictors in the course of com mon whiplash. We studied 107 subjects consecutively admitted to the Mu nicipality of Oslo Emergency Service hours after sustaining a whiplash injury. Acute assessment included clinical examination, a questionnai re about preaccident health problems, assessment of acute emotional re sponse to the injury (Impact of Event Scale (IES)), and visual analogu e scale (VAS) assessment of the acute pain. Four weeks after the injur y 93% of the subjects filled in a questionnaire about their symptoms i ncluding VAS-rated neck pain. A significant correlation between acute VAS neck pain and IES scores were found. At 4 weeks 42% of the subject s still reported significant pain problems. Seventy per cent of these subjects had high IES scores acutely, compared with only 26% in the lo w-pain group (p<0.0001). Neither the presence of neck pain acutely nor neck stiffness, headache, interscapular pain, and difference in speed between the patients car and the assaulting car predicted symptoms 1 month after injury. This is the first study assessing patients hours a fter whiplash injury. Our findings indicate that the acute psychologic responses to a whiplash incident is the strongest predictor of mainte nance of pain symptoms 4 weeks later. This finding seriously questions some authors' assumptions that psychosocial factors do not primarily influence the course of recovery from common whiplash.