October 8, 2009 / 5:37 PM / 8 years ago

Attitude may affect long-term recovery from whiplash

NEW YORK (Reuters Health) - For people who suffer whiplash in a car accident, feelings of being wronged may raise their risk of lingering post-traumatic stress, a new study suggests.

The study, which followed 112 patients in rehab for whiplash injuries, found that 45 percent had symptoms of post-traumatic stress disorder (PTSD) when they started treatment. And those with a greater sense of “perceived injustice” about their situation were more likely than others to still have PTSD symptoms at the end of their rehab program.

In fact, the study found, feelings of injustice -- in particular, feeling like the victim of someone else’s negligence -- were the only strong predictor of whether PTSD symptoms persisted.

Patients with more-severe pain and disability were at relatively greater risk of developing PTSD symptoms in the first place. But those physical symptoms were not related to the risk of lingering post-traumatic stress.

The researchers, led by Dr. Michael J. L. Sullivan of McGill University in Montreal, Canada, report their findings in the latest issue of the journal Pain.

They say their results raise the possibility that treating patients’ pain early on might prevent serious PTSD symptoms in the first place -- and that addressing people’s sense of injustice may help keep any symptoms from becoming chronic.

Other studies, the team notes, have pointed to the importance of psychological factors in recovery from whiplash -- an injury to the neck’s soft tissue, including muscles, ligaments and discs, which typically occurs during a car accident that sends the head and neck suddenly forward and back.

One recent study found that whiplash patients who were more optimistic about their recovery were less likely than their pessimistic counterparts to have disabilities six months later -- even when the severity of the injury was taken into account.

These latest findings suggest that attitude may also affect the odds of lingering PTSD, an anxiety disorder marked by symptoms such as nightmares or flashbacks of the traumatic event.

It is not clear how common PTSD is after whiplash injuries, but some studies suggest that up to 30 percent of patients have PTSD symptoms one month after their accident.

The higher rate seen in this study (45 percent) may owe to the fact that the patients had all been referred to a recovery program because they were still off of work eight weeks after their accidents, according to Sullivan’s team. Other research suggests that 60 percent to 70 percent of whiplash sufferers return to work within two months.

The researchers also stress that their findings point only to an association between perceived injustice and persistent PTSD; they do not prove that the former causes the latter.

SOURCE: Pain, October 2009.

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