@article{ref1,
title="Psychologic Processes in Daily Life With Chronic Whiplash: Relations of Posttraumatic Stress Symptoms and Fear-of-pain to Hourly Pain and Uptime",
journal="Clinical journal of pain",
year="2010",
author="Sterling, Michele and Chadwick, Benjamin J.",
volume="26",
number="7",
pages="573-582",
abstract="OBJECTIVES: Recent models of the relationship between posttraumatic stress and whiplash pain suggest that psychological stress relating to a motor vehicle crash may influence pain perception. The mechanisms of this relationship may be through more direct, psychological pathways, or through factors proposed by the fear-avoidance models of chronic pain. This study sought to investigate the relative contribution of fear-of-pain and trauma symptomatology to daily pain and time spent in an upright posture (uptime) in chronic whiplash-associated disorder (WAD). METHODS: Hourly electronic-diary reports were used to explore the within-day relationship of psychological trauma symptoms and fear-of-pain to same-hour and next-hour pain reports and next-hour uptime (measured by accelerometers) in 32 individuals with a chronic WAD. Within-person effects were analyzed for 329 diary entries using multilevel modeling with fixed slopes and random intercepts. RESULTS: Reports of trauma-related hyperarousal were associated with greater same-hour pain, and this relationship was mediated by fear-of-pain. Fear-of-pain and uptime were independently associated with reports of increased next-hour pain (controlling for first-order serial autocorrelation). Fear-of-pain was unrelated to next-hour uptime, but trauma-related avoidance symptoms were associated with reduced uptime. This study supports the relationship between psychological trauma responses and pain, suggesting behavioral (avoidance) pathways and effects on pain perception through fear-of-pain. These findings reinforce the need to evaluate traumatic stress as a factor in recovery from WAD.<p /> <p>Language: en</p>",
language="en",
issn="0749-8047",
doi="10.1097/AJP.0b013e3181e5c25e",
url="http://dx.doi.org/10.1097/AJP.0b013e3181e5c25e"
}