If they can put a man on the moon, they should be able to fix a neck injury: a mixed-method study characterizing and explaining pain beliefs about WAD

Abstract

Purpose: To use quantitative data characterizing whiplash-associated disorder (WAD)-related pain beliefs over time to develop qualitative analysis exploring experiences informing these beliefs. Method: A mixed-method design was used. Quantitative and qualitative data were collected concurrently at baseline and 3 and 6 months postmotor vehicle collision. WAD-related pain beliefs were quantitatively measured in a sample of adults with acute WAD. A subgroup of participants participated in an interview after each survey. Descriptive statistics quantitatively characterized beliefs at each measurement. High or low scores from survey beliefs subscales informed the semistructured interview. The qualitative component explored experiences informing endorsement of beliefs reported on the surveys using a meaning-focused approach. Results: Adjunctive meaning informing endorsement of beliefs related to cure, control, emotions and mystery was achieved. Qualitative analysis revealed a meta-theme labeled restitution, representing a desire to be “fixed”. Stigma also emerged as a potentially important contextual descriptor of WAD meaning. Conclusions: Restitution was the dominant underlying pattern of belief endorsement. While this may be adaptive early after WAD, it is problematic for meaning construction later on. Based on contemporary views on pain, identification of this narrative is important as it represents an incompatibility in the conceptualization of pain between patient and provider.Implications for RehabilitationThe restitution narrative (the desire to be fixed or cured) is common to the formation of meaning throughout all stages of whiplash-associated disorder (WAD) injury, even in people experiencing chronic pain.Viewing WAD through a lens of restitution is adaptive early after injury, but is problematic as WAD persists and/or becomes chronic.Since experts have advocated a shift from treatment to management of persistent pain, patient beliefs about WAD may contradict educational messages delivered by health providers.