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Need for More Research on Chronic Whiplash

Despite many studies, researchers still don't know why some people develop chronic pain after a whiplash injury and others don't. They haven't been able to predict who will have lasting pain and who won't.

In this article on chronic whiplash syndrome, the model of fear-avoidance behavior (FAB) is reviewed. FAB refers to the idea that some people in pain start to avoid movement that they think might cause pain.

The fear of pain results in movement avoidance behaviors. Attitudes and beliefs of this type fall into the category of psychologic risk factors. The FAB model is one that has worked well in understanding and treating people with chronic low back pain.

Perhaps it would help explain the transition from acute to chronic whiplash. Injured patients may get trapped in a downward spiral as pain leads to avoidance, which results in disability and more pain.

But so far, two systematic reviews looking at the evidence haven't confirmed the role of psychologic factors in chronic whiplash. One other study has shown that an acute injury is more likely to result in FAB compared with patients who had a gradual onset of pain. More research is needed to clear up the inconsistent findings on this topic.

The authors of this review suggest the FAB model has some merit in chronic whiplash. They based this conclusion on their review of all relevant studies. Problems in the design of the two systematic reviews may help explain the inconclusive results reported.

Suggestions for future research include studies over a long period of time to look for factors that predict the final outcome. These factors might include high level of anxiety and early symptoms of acute traumatic stress.

Studying the FAB model in chronic whiplash patients may help guide future research. Screening tools to identify patients at risk after injury may help direct treatment choices for acute and chronic pain patients.

References: Karoline Vangronsveld, et al. Applying the Fear-Avoidance Model to Chronic Whiplash Syndrome. In Pain October 2007. Vol. 130. No. 3 Pp. 258-261.

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