Abstract
Whiplash injury is a common consequence of motor vehicle crashes (MVC), yet it is also one of the most poorly understood. While more than 50% of those injured should expect to rapidly recover, others are not as fortunate with approximately 25% of those exposed to and injured in an MVC transitioning from acute to chronic pain and disability. The purpose of this prospective study was to determine if the severity and direction of collisions involving participants enrolled in a longitudinal study of recovery from whiplash are able to differentiate between different recovery groups based on the neck disability index (NDI) percentage scores at 3-months, and if these crash specific parameters are associated with known risk factors for recovery. Here, we examined objective collision data, repair invoices, and characteristics of the crash for 37 acutely injured participants consented and enrolled at their emergency department visit and further assessed at three time points; < 1 week, 2-weeks, and 3-months post MVC. Collision data were used to reconstruct and estimate the severity of the crash and determine if they aligned with the heterogeneity of whiplash injury recovery. Wilcoxon rank sum tests were used to determine if % scores on the Neck Disability Index (NDI) at 3-months post MVC were associated with the following variables: sex, head turned at time of impact, seatbelt use, whether or not airbags deployed, if the vehicle was struck while stopped or while turning, or the principle direction of force (PDOF). Spearman’s correlation coefficients were used to determine if NDI at 3-months post MVC was associated with age, Body Mass Index, pain-related disability at baseline, signs of post-traumatic distress, intrusion/hyperarousal, negative affect, pain intensity, estimated speed change from the impact, and damage estimates (in US$). There was a significant positive association between self-reported neck disability at 3-months post MVC, post-traumatic distress, negative affect and uncontrolled pain. There was no direct effect of participant characteristics, arousal, intrusion/hyperarousal sub-score, damage, PDOF, speed change, or other crash characteristics. Established crash parameters were not associated with the heterogeneity of whiplash injury recovery in a small sample of injured participants.
Highlights
Neck pain and related symptoms arising from non-catastrophic injuries following a motor vehicle collision can significantly influence quality of life for some, but not all, vehicle occupants
Sub-catastrophic ligament failures have been generated in cadaveric tissues following whiplash-like loading;[30,31,32] nociceptor activation occurs when the facet capsular ligament is stretched in an in-vivo caprine model;[33] chronic pain states have been shown by straining this ligament in an in-vivo rodent model;[30] and successful diagnostic blocks and ablation treatments targeting these tissues have shown to improve pain and negative affect in a sub-group of human participants.[34,35,36]
There was no direct effect of participant characteristics, PDS Arousal, Traumatic Injuries Distress Scale (TIDS) intrusion/hyperarousal sub-score, damage, principle direction of force (PDOF), speed change, or other crash characteristics (Tables 4 and 5) on self-reported neck disability
Summary
Neck pain and related symptoms arising from non-catastrophic injuries following a motor vehicle collision (colloquially known as whiplash injury) can significantly influence quality of life for some, but not all, vehicle occupants. Sub-catastrophic ligament failures have been generated in cadaveric tissues following whiplash-like loading;[30,31,32] nociceptor activation occurs when the facet capsular ligament is stretched in an in-vivo caprine model;[33] chronic pain states have been shown by straining this ligament in an in-vivo rodent model;[30] and successful diagnostic blocks and ablation treatments targeting these tissues have shown to improve pain and negative affect in a sub-group of human participants.[34,35,36] The picture for other organic lesions, remains far less complete.[29]
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