There’s Nothing Broken. You’ve Had a Whiplash, That’s It: A Qualitative Study of Comorbid Posttraumatic Stress Disorder and Whiplash Associated Disorders

Abstract

Background Posttraumatic stress disorder (PTSD) symptoms are common in chronic Whiplash associated disorders (WAD) and have been found to be associated with higher levels of pain and disability. Theoretical frameworks have suggested that PTSD and pain not only coexist, but also mutually maintain one another. Although the comorbidity has been subject to increasing quantitative research, patients’ experiences of the comorbidity and symptom interaction remain largely uninvestigated using qualitative methods. Objective The present study set out to explore the potential relationship of PTSD and pain in people with WAD and properly assessed PTSD after motor vehicle accidents. Methods A qualitative explorative study of eight individual face-to-face semistructured interviews were conducted. Interviews were recorded and transcribed verbatim and analyzed using framework analysis. Results Through the analysis, we developed three overarching themes. The first theme illustrated the complex and burdensome comorbidity with overlapping and transdiagnostic symptoms, whereas the second theme highlighted how several circumstances, some related to the health care system, could extend and amplify the traumatic response. The final theme illustrated symptom associations and interactions, particularly between pain and PTSD, both supporting and rejecting parts of the mutual maintenance framework. Conclusions These findings underlined the great complexity and variability of the comorbidity and the traumatic event, but also emphasized how experiences of psyche and soma seem closely connected in these patients. The results provide support for the importance of thorough assessment by multidisciplinary teams, minimizing distress post-injury, and a critical approach to the idea of mutual maintenance between pain and PTSD.

Pain after a motor vehicle crash: The role of socio‐demographics, crash characteristics and peri‐traumatic stress symptoms

“…Motor vehicle collisions (MVCs) in particular are one of the most common life-threatening traumatic stress exposures and even minor MVCs can result in high morbidity from chronic pain and other APNS (Ravn et al, 2019(Ravn et al, , 2020. In the US there are over 4 million ED visits related to MVCs each year (Albert & McCaig, 2015).…”

“…Historically such pain was attributed to tissue injury, but more recently neurobiological stress systems have been implicated in both posttraumatic psychologic symptoms and pain persistence after physical trauma (McLean, 2016). Furthermore, the development of post-traumatic stress disorder and chronic pain are often co-morbid, suggesting potentially a shared neurobiological mechanism (Ravn et al, 2020). Targeting acute peritraumatic stress after trauma has also been shown to improve pain outcomes (Sterling et al, 2019) and other APNS (Gil-Jardine et al, 2018).…”

Psychologische Psychotherapie bei persistierenden Schmerzen nach einer HWS-Distorsion

“…PTBS-Symptome stellen für die Betroffenen eine weitere Krankheitslast dar. In diesem Kontext weisen Sophie Ravn et al in einer aktuellen Untersuchung darauf hin, dass sich Schmerz-und PTBS-Symptome gegenseitig aufrechterhalten können [11].…”

“…Das komplexe Zusammenspiel von psychischen, körperlichen und sozialen Faktoren bei chronischen Schmerzen kann Kliniker aus vorrangig somatisch oder psychologisch orientierten Disziplinen verunsichern. Um diese Verunsicherung abzubauen und um das biopsychosoziale Modell praktisch anzuwenden, ist eine effektive interdisziplinäre Kommunikation notwendig [11].…”

Somatic Experiencing® for patients with low back pain and comorbid posttraumatic stress symptoms – a randomised controlled trial

“…Factors such as catastrophising, hyperarousal and avoidance behaviours may maintain and exacerbate both pain and PTSS. Also, when pain and PTSS are tied to the same event, pain symptoms may serve as a reminder of the traumatic event and thereby lead to re-experiencing symptoms (Ravn, Eskildsen, Johnsen, Sterling, & Andersen, 2020 ). Hence, targeting these potentially mutually maintaining mechanisms with an additional psychotherapeutic intervention designed to treat PTSS may also have a positive impact on pain related disability and distress (Asmundson & Katz, 2009 ; Sharp & Harvey, 2001 ).…”