(239) Stress-related psychological symptoms contribute to neck pain persistence after motor vehicle collision: path analysis results from a prospective longitudinal study

Abstract

Peritraumatic distress symptoms and subsequent posttraumatic stress disorder (PTSD) symptoms after motor vehicle collision (MVC) have been proposed to promote the development of MVC-related neck pain (MRNP) via a number of mechanisms. We used a path analysis model to evaluate longitudinal associations between peritraumatic distress symptom clusters (life threat, helplessness/anger, loss of control, and guilt/shame, assessed in the emergency department (ED) using the Peritraumatic Distress Inventory), PTSD symptom clusters (avoidance, intrusion/re-experiencing, and hyperarousal, assessed 6 weeks, 6 months, and one year after MVC using the Impact of Events Scale-Revised (IES-R)), and MRNP severity (assessed via 0-10 NRS at each timepoint). Of note, patients reporting neck pain at any timepoint were asked whether their pain was MVC-related; only MRNP was included in analyses. Analyses were performed in Mplus using data from a prospective cohort study of European Americans (n = 948) who presented to the ED within 24 hours of MVC and were discharged to home. ED evaluation was performed via in-person interview and follow-up interviews were performed via telephone interview or internet-based questionnaire. Confirmatory factor analyses of distress and IES-R subscales indicated acceptable fits to the data (RMSEA/CFI of 0.084/0.933 and 0.051/0.958 respectively). Overall fit of the longitudinal model of relationships between distress and PTSD subscales and MRNP was excellent (RMSEA = 0.049 [90% CI 0.036 to 0.052] in trimmed model). Peritraumatic helplessness/anger in the ED predicted 6 week MRNP severity (β = .148, p < 0.0001). Six week and six month PTSD hyperarousal symptoms, but not avoidance or intrusion symptoms, partially mediated the relationship between MRNP at six weeks and six months and between MRNP at six months and one year, respectively. These results support the hypothesis that stress-related psychological symptoms contribute to/mark vulnerability to persistent MRNP after MVC. Supported by NIAMS R01AR056328. Peritraumatic distress symptoms and subsequent posttraumatic stress disorder (PTSD) symptoms after motor vehicle collision (MVC) have been proposed to promote the development of MVC-related neck pain (MRNP) via a number of mechanisms. We used a path analysis model to evaluate longitudinal associations between peritraumatic distress symptom clusters (life threat, helplessness/anger, loss of control, and guilt/shame, assessed in the emergency department (ED) using the Peritraumatic Distress Inventory), PTSD symptom clusters (avoidance, intrusion/re-experiencing, and hyperarousal, assessed 6 weeks, 6 months, and one year after MVC using the Impact of Events Scale-Revised (IES-R)), and MRNP severity (assessed via 0-10 NRS at each timepoint). Of note, patients reporting neck pain at any timepoint were asked whether their pain was MVC-related; only MRNP was included in analyses. Analyses were performed in Mplus using data from a prospective cohort study of European Americans (n = 948) who presented to the ED within 24 hours of MVC and were discharged to home. ED evaluation was performed via in-person interview and follow-up interviews were performed via telephone interview or internet-based questionnaire. Confirmatory factor analyses of distress and IES-R subscales indicated acceptable fits to the data (RMSEA/CFI of 0.084/0.933 and 0.051/0.958 respectively). Overall fit of the longitudinal model of relationships between distress and PTSD subscales and MRNP was excellent (RMSEA = 0.049 [90% CI 0.036 to 0.052] in trimmed model). Peritraumatic helplessness/anger in the ED predicted 6 week MRNP severity (β = .148, p < 0.0001). Six week and six month PTSD hyperarousal symptoms, but not avoidance or intrusion symptoms, partially mediated the relationship between MRNP at six weeks and six months and between MRNP at six months and one year, respectively. These results support the hypothesis that stress-related psychological symptoms contribute to/mark vulnerability to persistent MRNP after MVC. Supported by NIAMS R01AR056328.