Citation

Buitenhuis JJ, de Jong PJ. Spine 2011; 36(25 Suppl): S238-43.

Affiliation

Medical Department, Univé Insurance and Department of Health Sciences, University Medical Center Groningen, University of Groningen, the Netherlands, Department of Clinical Psychology, University of Groningen, the Netherlands.

Copyright

(Copyright © 2011, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0b013e3182388400

PMID

22020599

Abstract

STRUCTURED ABSTRACT: Study Design. A descriptive overview of the relevant literature and the introduction of a new psychological model.Objective. The fear-avoidance (FA) model and the potential importance of illness beliefs in posttraumatic neck pain are discussed. The Causal beliefs-anxiety (CBA) model is introduced as an adaptation of the FA model, emphasizing the critical role of illness beliefs.Summary of Background Data. Although the FA model is most thoroughly used to investigate chronic low back pain, it seems also highly relevant as a starting point for other chronic pain conditions like whiplash. Kinesiophobia and Pain catastrophizing form critical components of the FA model. It has been shown that breaking the fear-avoidance cycle by affecting the critical components of the model may be an effective method to prevent the development of chronicity.Methods. By using the FA model as a starting point we present the CBA model and argue how this might help explain chronic whiplash symptoms and might provide clues for preventive interventions.Results. On experiencing muscular neck pain, catastrophizing may give rise to dysfunctional illness beliefs regarding the cause of this pain. The illness identity and other beliefs feed symptom expectation and attribution, as well as expectations regarding the course of muscular neck pain. These negative expectations can contribute to a less favourable outcome or may even cause symptoms. Therefore, it seems important to integrate the alleged role of illness beliefs in an adapted FA model, the 'causal beliefs-anxiety model'.Conclusion. In clinical practice, it seems important to have insight into the patient's illness beliefs about the cause of the experienced symptoms. Healthcare professionals should be aware of the possible detrimental influence of dysfunctional illness beliefs. In the early stage adequate explanation and information about the probable course may be sufficient to prevent the generation of dysfunctional illness beliefs thereby preventing the development of a chronic course. At the population level educational campaigns that inform people about probable causes and realistic expectations regarding post-traumatic neck pain could provide an effective strategy for preventing chronic whiplash symptoms.

Language: en