Centre for National Research on Disability and Rehabilitation Medicine (CONROD), University of Queensland, Queensland, Australia.
Pain. 2011 Jun;152(6):1272-1278. doi: 10.1016/j.pain.2011.01.056. Epub 2011 Mar 10.
Distinct developmental trajectories for neck disability and posttraumatic stress disorder (PTSD) symptoms after whiplash injury have recently been identified. This study aimed to identify baseline predictors of membership to these trajectories and to explore their dual development. In a prospective study, 155 individuals with whiplash were assessed at <1 month, 3, 6, and 12 months postinjury. Outcomes at each time point were assessed according to the Neck Disability Index and the Posttraumatic Stress Diagnostic Scale. Baseline predictor variables were age, gender, initial pain (based on a visual analogue scale [VAS]), pressure pain thresholds (PPT), cold pain thresholds (CPT), and sympathetic vasoconstrictor responses. Group-based trajectory analytical techniques were used to parameterise the optimal trajectories and to identify baseline predictors. A dual trajectory analysis was used to explore probabilities of conditional and joint trajectory group membership. CPT > or = 13° C (OR = 26.320, 95% CI = 4.981-139.09), initial pain level (VAS) (OR = 4.3, 95% CI = 4.98-139.1), and age (OR = 1.109, 95% CI = 1.043-1.180) predicted a chronic/severe disability trajectory. The same baseline factors also predicted chronic moderate/severe PTSD (CPT > or = 13° C, OR = 9.7, 95% CI = 2.22-42.44; initial pain level [VAS]: OR = 2.13, 95% CI = 1.43-3.17; age: OR = 1.07, 95% CI = 1.01-1.14). There was good correspondence of trajectory group for both disability and PTSD. These findings support the proposal of links between the development of chronic neck related disability and PTSD after whiplash injury. Developmental trajectories of disability and posttraumatic stress disorder (PTSD) after whiplash injury are mostly in synchrony, and similar factors predict their membership. This suggests links between the development of chronic neck pain-related disability and PTSD.
颈痛障碍和创伤后应激障碍（PTSD）症状在挥鞭伤后的发展轨迹最近已被确定。本研究旨在识别这些轨迹的基线预测因素，并探讨其双重发展。在一项前瞻性研究中，对 155 名挥鞭伤患者在受伤后<1 个月、3、6 和 12 个月进行评估。根据颈痛障碍指数和创伤后应激障碍诊断量表评估每个时间点的结局。基线预测变量包括年龄、性别、初始疼痛（基于视觉模拟量表[VAS]）、压力疼痛阈值（PPT）、冷痛阈值（CPT）和交感神经血管收缩反应。使用基于群组的轨迹分析技术来参数化最佳轨迹并识别基线预测因素。使用双轨迹分析来探讨条件和联合轨迹组成员资格的概率。CPT≥13°C（OR=26.320，95%CI=4.981-139.09）、初始疼痛水平（VAS）（OR=4.3，95%CI=4.98-139.1）和年龄（OR=1.109，95%CI=1.043-1.180）预测慢性/严重残疾轨迹。同样的基线因素也预测慢性中度/重度 PTSD（CPT≥13°C，OR=9.7，95%CI=2.22-42.44；初始疼痛水平[VAS]：OR=2.13，95%CI=1.43-3.17；年龄：OR=1.07，95%CI=1.01-1.14）。残疾和 PTSD 的轨迹组之间有很好的对应关系。这些发现支持了挥鞭伤后慢性颈部相关残疾和 PTSD 发展之间存在联系的观点。挥鞭伤后残疾和创伤后应激障碍（PTSD）的发展轨迹大多同步，相似的因素预测其归属。这表明慢性颈部疼痛相关残疾和 PTSD 的发展之间存在联系。
