Post-trauma ratings of pre-collision pain and psychological distress predict poor outcome following acute whiplash trauma: A 12-month follow-up study

Patients with acute whiplash trauma were followed to examine if post-trauma ratings of pre-collision pain and psychological distress were associated with reduced work capability and neck pain at 12 months follow-up. The study included 740 consecutive patients 1474 females, 266 males) referred from emergency departments or primary care after car accidents in four countries in Denmark. After the collision patients received a questionnaire on psychological distress, unspecified pain and socio-demographics and 12 months later a follow-up on work capability and neck pain was performed. Risk factors were identified by multiple logistic regression analysis. Factors associated with affected work capacity at the 12-month follow-up were pre-collision unspecified pain condition (OR = 2.4, p = 0.002) and socio-demographic characteristics: female gender, low educational level, unemployment and blue collar worker. Factors asociated with considerable neck pain at follow-up were pre-collision unspecified pain (OR = 3.5, p < 0.000), pre-collision high psychological distress (OR = 2.1, p = 0.03) and socio-demographic characteristics; female gender and formal eduation >4 years. Pre-collision neck pain and severity of accident were not associated with poor outcome. In causality can be drawn. Personal characteristics before the collision are poor outcome. In conclusion unspecified as opposed to specified pain (neck pain) before the collision is associated with poor recovery and high accumulation of pre-collision psychological distress is associated with considerble neck pain at follow-up. However, no conclusions no causality can be drawn. Personal characteristics before the collision are important for recovery and attention to pre-collision characteristics may contribute to the prevention of poor recovery after acute whiplash trauma. (c) 2008 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.