Citation

Ravn SL, Karstoft KI, Sterling M, Andersen TE. Eur. J. Pain 2019; 23(3): 515-525.

Affiliation

Department of Psychology, University of Southern Denmark, Denmark.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1002/ejp.1325

PMID

30318773

Abstract

BACKGROUND: Posttraumatic stress disorder (PTSD) symptoms are highly prevalent after whiplash and associated with pain-related symptoms. While mutual maintenance between pain and PTSD has been suggested, knowledge on individual differences in the course of these symptoms is needed. The present study aimed to identify trajectories of PTSD symptoms following whiplash and test predictors and functional outcomes of such trajectories.

METHODS: In a prospective cohort design with assessments at baseline (<4 weeks), 3 months, and 6 months post-injury (n=229, whiplash-grade I-III), we identified PTSD-trajectories using Latent Growth Mixture Modeling. Predictors (pain, fear-avoidance-beliefs, pain-catastrophizing, depression, age, and gender) were tested using multinomial logistic regression, and group mean differences in physical and psychosocial pain-related disability at 6 months after controlling for baseline levels were tested as outcomes.

RESULTS: Three trajectories were identified: "Resilient" (75.1%) with little or no PTSD symptoms over time, "Recovering" (10.0%) with high initial PTSD symptom levels, then decreasing substantially, and "Chronic" (14.9%) with high initial PTSD symptom levels and a small increase over time. Initial higher pain and depression levels predicted the recovering and chronic trajectories, while the latter had more pain-related disability at 6 months compared to both other trajectories.

CONCLUSIONS: Three trajectories were identified, with the chronic trajectory suggesting that a significant subset of people does not recover from PTSD symptoms. This class also reported more pain-related disability. Pain and depression predicted membership, but did, however, not succeed in differentiating between the two high-starting trajectories, suggesting that targeting PTSD symptoms may be important to ensure recovery. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en

Keywords

PTSD; pain; pain-related disability; posttraumatic stress symptoms; prospective study; trajectories; whiplash