Science has yet to explain chronic pain. While it has long been known that many injured in car accidents never recover, the precise explanation for this remains unclear. A growing body of medical literature demonstrates that PTSD may play a role.
“Our results showed that high level of catastrophizing and PTSD are predictors of chronic WAD [whiplash-associated disorders] at the early stage. This result is consistent with previous study that investigated PTSD symptoms detrimental influence on the recovery and severity of whiplash complaints following car accidents. More specifically, this research showed that the number of hyperarousal symptoms, a dimension of PTSD, at the early stage was found to be related to the persistence and severity of post-whiplash syndrome symptoms at both 6- and 12-month follow-up. Similarly, Kongsted et al. showed that post-traumatic stress response after a whiplash injury was associated with 1-year physical outcome, such as long-lasting pain, poor physical health and reduced working ability. Finally, Sterling et al. reported also that PTSD is a predictor of poor outcome at long-term follow-up. Chronic pain resulting from whiplash injury has often been related to feelings of anxiety. This anxiety is not just a consequence of chronic pain but it can also play an important role in accentuating the sensation of pain.”
How does anxiety accentuate the pain? What is the physiologic pathway by which this occurs? Are the body’s natural defense mechanisms compromised? How?
“As stated in the Section “Introduction,” the mechanisms behind the transition from acute to chronic WAD remain to be elucidated and in particular the evaluation of the impact of multiple risk factors in a single patient…All chronic patients exhibited high level of catastrophizing at the acute stage and/or PTSD. Their head and trunk motor control values, and in some cases vestibular tests ones, are far from the healthy group. Our “looking for an early detection of poor outcome after whiplash” analysis tested which combination of these symptoms could predict the passage to chronicity in the patients we evaluated test twice over a 6-month period. The outcome is clear and this is the main result of our study: patients displaying high level of catastrophizing at the acute stage and/or PTSD associated with either anomalies in head or trunk kinematics, in the otolithic function and at the Equitest or a combination of these syndromes, turned to chronicity. That is, the association of a neuropsychological disorder with a somatic one was sufficient to explain the passage to chronicity.”
“Practically speaking, the results of this study are in line with previous results and suggest that low-grade whiplash patients should be submitted as early as possible after the trauma to neuropsychological and motor control tests in a dedicated consultation. In addition, they should be sent to a neuro-otologist for a detailed examination of vestibular functions, which should include cVEMP. Then, if diagnosed at risk of WAD, these patients should be submitted to an intensive preventive rehabilitation program, including vestibular rehabilitation if required. Indeed, it decreases self-perceived handicap and improves postural control in patients with vestibular syndromes.”
For those who handle car accidents, knowledge of this can help clarify and establish damages. The reason pain persists is often due to a partial diagnosis. Testing from qualified consultants––a neuropsychologist, a neuro-otologist––can help fill in what’s missing. Pain and anxiety, anxiety and pain––discovering the science behind this relationship is a medical breakthrough just waiting to happen. The reason why no one has discovered this yet is because anxiety is deemed to be a purely psychological phenomenon (as opposed to physical). But the body recognizes no such dichotomy––anxiety can be as painful as any other symptom, perhaps more so. A new way of seeing is required––one where mind and body are recognized as one.
All quotations from Sebastien Laporte, Danping Wang, Jennyfer Lecompte, Sophie Blancho, Baptiste Sandoz, Antoine Feydy, Pavel Lindberg, Julien Adrian, Elodie Chiarovano, Catherine de Waele, Pierre-Paul Vidal, An Attempt of Early Detection of Poor Outcome After Whiplash, Front Neurol, 2016; 7:177 (2016 October 20) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072109/