Over 1.8 million people in the US suffer from chronic pain and disability following motor vehicle accidents (MVAs) each year. The majority of these cases start with a relatively minor neck injury. Although little is known about what predicts chronicity of whiplash-associated disorders (WADs), research on chronic musculoskeletal pain following injury suggests that initial emotional reactivity, particularly fears of reinjury and avoidance of activity, contributes significantly to chronicity of pain and disability. Based on this model, early interventions to reduce avoidance and inactivity have been shown to prevent chronic pain following back injury. This is the first study to evaluate interventions with WAD sufferers within 3 months of an MVA. The interventions are integrated biobehavioral approaches based on an anxiety-reduction model consisting of information, relaxation training, and imaginable and actual exposure to feared physical activities. The primary purpose of this application is to conduct a clinical trial testing interventions to prevent chronic WAD pain and disability. The study will also delineate factors associated with the development of chronic symptoms and disability following initial WADs within a diathesis-stress model. Three hundred (225 symptomatic, 75 asymptomatic) post MVA, whiplash victims will be included. Symptomatic subjects will receive one of 3 treatment conditions: (1) standard care + an information booklet; (2) 3 didactic sessions with a physician, psychologist and physical therapist (PT) providing information regarding WAD and exercise, or (3) 3 treatment sessions with a physician, psychologist and PT that includes physical exercise, relaxation training, and exposure-based strategies to reduce anxiety associated with physical activity. We will evaluate the efficacy of these treatments using pain, physical, behavioral, cognitive, and affective outcomes at the post-treatment and 6-month follow-up. Additionally, we will examine the presence and degree of known risk factors, both accident-related and prepositional variable (e.g., negative affectivity) for the persistence of the WAD symptoms following MVAs. The data from this trial will provide important information about the potential of early interventions to prevent chronic problems that afflict millions of MVA victims.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR047298-02
Application #
6512234
Study Section
Special Emphasis Panel (ZRG1-RPHB-3 (01))
Program Officer
Panagis, James S
Project Start
2001-03-09
Project End
2006-02-28
Budget Start
2002-03-01
Budget End
2003-02-28
Support Year
2
Fiscal Year
2002
Total Cost
$416,169
Indirect Cost
Name
University of Washington
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
135646524
City
Seattle
State
WA
Country
United States
Zip Code
98195
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Robinson, James P; Turk, Dennis C (2013) Cure by fiat? Pain 154:2235-7
Robinson, James P; Theodore, Brian R; Wilson, Hilary D et al. (2011) Determination of fibromyalgia syndrome after whiplash injuries: methodologic issues. Pain 152:1311-6
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Robinson, James P; Burwinkle, Tasha; Turk, Dennis C (2007) Perceived and actual memory, concentration, and attention problems after whiplash-associated disorders (grades I and II): prevalence and predictors. Arch Phys Med Rehabil 88:774-9
Thieme, Kati; Turk, Dennis C; Flor, Herta (2007) Responder criteria for operant and cognitive-behavioral treatment of fibromyalgia syndrome. Arthritis Rheum 57:830-6
Nederhand, Marc J; Hermens, Hermie J; Ijzerman, Maarten J et al. (2006) The effect of fear of movement on muscle activation in posttraumatic neck pain disability. Clin J Pain 22:519-25
Thieme, Kati; Turk, Dennis C (2006) Heterogeneity of psychophysiological stress responses in fibromyalgia syndrome patients. Arthritis Res Ther 8:R9
Thieme, Kati; Flor, Herta; Turk, Dennis C (2006) Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments. Arthritis Res Ther 8:R121
Burwinkle, Tasha; Robinson, James P; Turk, Dennis C (2005) Fear of movement: factor structure of the tampa scale of kinesiophobia in patients with fibromyalgia syndrome. J Pain 6:384-91

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