Article:
Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability published in Pain Reports.
DOI: 10.1097/PR9.0000000000000631
Current research shows that Post-traumatic Stress Disorder (PTSD) is related to Whiplash Associated Disorder (WAD) and chronic neck pain. These authors set out to determine which specific PTSD symptoms are more predictive of chronic neck pain in individuals suffering from WAD due to a MVC. The authors examined a sample of 146 individuals with an acute, painful whiplash injury from a MVC. They monitored neck pain symptoms using the Neck Pain Disability Index (NDI), and any potential PTSD symptoms with the Post-traumatic Stress Diagnostic Scale (PDS). These items were assessed at baseline (within 1 month of injury) and again 6 months later. Thirty percent of the participants met the threshold for a PTSD diagnosis, and the remaining 70% had symptoms of PTSD but did not qualify for the full diagnosis.
A confirmatory factor analysisa was performed to determine separate clusters of symptoms on the PDS that could potentially affect neck pain. The results showed two clusters, one deemed the “re-experience/avoidance” cluster and the other the “hyperarousal/numbing” cluster. The avoidance cluster of symptoms included recurrent recollections, recurrent dreams, reliving trauma, psychological distress, physiological reactivity, avoiding thoughts, behavioral avoidance, hypervigilance, and exaggerated startle response. The hyperarousal cluster symptoms included diminished interest in activities, sense of foreshortened future, difficulty sleeping, difficulty concentrating, detachment from others, restricted affect, irritability and anger.
The results of the study showed that the hyperarousal/numbing cluster was the only cluster of symptoms associated with long-term neck pain1. The authors theorized as to why this might be the case. They discussed how inactivity and sleep deprivation could potentially stem from the hyperarousal symptoms. For example, diminished interest in activity, difficulty concentrating, and irritability could all impact the individual’s ability to work, leading to more inactivity. Additionally, difficulty sleeping is a symptom that could understandably lead to increased pain and decreased levels of activity.
However, the authors noted the apparent “non-specificity” of the hyperarousal cluster’s symptoms– meaning they are a group of symptoms that appear in various mental health disorders and are not necessarily specific to PTSD. In contrast, they labeled the avoidance cluster symptoms as typically “specific” to PTSD and not appearing in many other mental health disorders. Therefore, if the hyperarousal cluster of symptoms are present in a patient, one must be careful not to assume PTSD is present. The symptoms could simply be a result of the physical whiplash injury itself, and not stemming from any psychological trauma. More research is needed to be certain.
In conclusion, symptoms such as diminished interest in activities, difficulty sleeping, difficulty concentrating, detachment, irritability and anger may be present in individuals suffering from neck pain after an injury. These symptoms may stem from psychological trauma accompanying the injury, or could perhaps be normal, expected coping mechanisms for neck pain. Regardless, these particular symptoms are indicative of a longer prognosis of recovery and may warrant consideration for referral to a psychologist.
Footnote:
a. Confirmatory factor analysis: “a technique used to analyze the efficacy of measurement models where the number of factors and their direct relationship is specified” In this case, it was done to determine which particular symptoms have similar elements and are likely to have similar effects on neck pain and dysfunction.
References:
Maujean A, Gullo MJ, Andersen TE, Ravn SL, Sterling M. Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability. Pain Rep. 2017;2(6):e631. Published 2017 Nov 27. doi:10.1097/PR9.0000000000000631
Price LA, Confirmatory factor analysis: foundations and extensions. International Encyclopedia of Education (Fourth Edition), Elsevier. Published 2023. 607-618. doi:10.1016/B978-0-12-818630-5.10016-8.