By accident: the prevention of chronic neck pain after a motor vehicle accident

摘要

Chronic neck pain is often the result of motor vehicle accidents, rear-end collisions in particular. A striking pattern of complaints often occurs after the accident. It is estimated that ca. 20% of patients with an acute neck pain episode develop chronic neck pain, also called 'chronic whiplash syndrome'. So far, studies focusing on medical predictors have not found conclusive evidence that biomedical factors contribute to the development and persistence of complaints. Bio-psychosocial models such as the Fear-Avoidance model and the Post-Traumatic Stress model seem more promising in explaining chronic complaints. The prevention of both acute and chronic pain and complaints after a motor vehicle accident is complex. Primary prevention is mostly focused on biomechanics, such as headrests and seatbelts. However, these type of studies are confronted with ethical boundaries and challenges in research. Secondary prevention seems to give promising results for two factors, being education and activation. Both factors are linked to catastrophic beliefs of patients about their pain and the possible harmfulness of being active. These catastrophic beliefs appear to be even more important when it comes to tertiary prevention, the treatment of chronic complaints after a motor vehicle accident. Catastrophic beliefs are elevated in people with chronic pain and need to be the primary target within interventions. However, research on the prevention of complaints lacks a sound theoretical framework and strong recommendations about the implementation of strategies cannot be made.