Pain‐catastrophizing and fear‐avoidance beliefs as mediators between post‐traumatic stress symptoms and pain following whiplash injury – A prospective cohort study

Abstract

The present study adds important knowledge about the development of psychological distress and pain after whiplash injury. The finding, that PCS and FA mediated the effect of PTSS on pain intensity is a novel finding with important implications for prevention and management of whiplash-associated disorders. WHAT DOES THIS STUDY ADD?: The study confirms the mechanisms as outlined in the fear-avoidance model and the mutual maintenance model. The study adds important knowledge of pain-catastrophizing and fear-avoidance beliefs as mediating mechanisms in the effect of post-traumatic stress on pain intensity. Hence, cognitive behavioural techniques targeting avoidance behaviour and catastrophizing may be beneficial preventing the development of chronic pain.

Evaluation of Candidate Items for Severe PTSD Screening for Patients With Chronic Pain: Pilot Data Analysis With the IRT Approach

“…Additionally, theta scores were positively associated with PROMIS‐Depression T scores ( r = 0.43, P = 0.001), as well as Pain interference, Pain behaviors, Fatigue, Sleep disturbance, Sleep impairment, and Social isolation T scores ( r s = 0.38 to −0.51, P s < 0.01). These results demonstrate that more severe PTSD was associated with greater pain, severe depressive symptoms, worse physical health status, and greater pain‐related interference, as expected from other study findings …”

“…The overlap between PTSD and chronic pain is not fully accounted for by traumatic etiology of chronic pain . Greater PTSD symptoms are associated with greater pain severity, emotional distress, and disability . Therefore, it is recommended that trauma history and PTSD symptoms be routinely assessed among patients with chronic pain .…”

The Relationship Between Posttraumatic Stress Disorder and Chronic Pain in People Seeking Treatment for Chronic Pain

“…The results are in line with previous studies suggesting that cognitive fusion and similar processes, such as decentering and cognitive inflexibility, are related to functioning in chronic pain and separately to the severity of PTSD [27,28,30,68], and with models of PTSD which specify that the way a person processes and interprets an traumatic event plays an important role in the development and maintenance of symptoms and in response to treatment for PTSD [20,69,70]. Furthermore, the results are in accordance with a recent study where catastrophizing and fear-avoidance beliefs, other types of dysfunctional cognitive processes, have been identified as mediating factors of the relationship between PTSD and pain intensity [15]. This is because in contextual terms it is fusion that activates the impact of cognitive content.…”

“…More recently, Andersen, Karstoft et al (2016) assessed 198 individuals for pain intensity and psychological distress within 3 weeks after whiplash injury and again 3-and 6-months later. Pain catastrophizing and fear avoidance beliefs were found to mediate the effect of PTSD symptoms on pain [15].…”

“…Mediation models should be chosen through assumptions that are either invoked based on theory or fulfilled by design features [56]. In accordance with this, our mediation models were based on earlier longitudinal research, which has highlighted the long term impact of PTSD symptoms on pain intensity [14] and has identified mechanisms that mediate the effect of PTSD symptoms on pain intensity [15], and cross-sectional research, which has investigated mediators of the relationship between PTSD and chronic pain [18][19][20][21]. The mediation models were also strengthened by the current data, which showed that the trauma producing the current PTSD symptoms happened on average 3-5 years prior to the time that the measures of pain and psychological flexibility were administered.…”