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In Whiplash Recovery, the Mind Matters

Certain psychological factors are associated with persistent disability and pain 1 year after a whiplash injury and can be proactively addressed with targeted interventions.


  • Investigators prospectively studied 164 patients in Spain who had acute or subacute whiplash injury from a motor vehicle collision, with pain present for less than 3 months after the injury.

  • The patients were asked about pain-related measures: self-efficacy beliefs, expectation of recovery, pain catastrophising, optimism and pessimism, pain intensity, and kinesiophobia (fear of pain due to movement).

  • The main outcome was non-recovery based on perceived disability (Neck Disability Index score) and perceived recovery (Likert scale rating).


  • One year after the whiplash injury, 24.4% of the patients were classified as not recovered based on their perceived disability.

  • The odds of not recovering in this regard rose with a patient's age (odds ratio, 1.04), level of pain catastrophising (1.11), and perceived disability (1.20) at baseline.

  • One year after the whiplash injury, 50.0% of the patients were classified as not recovered based on their perceived recovery.

  • The odds of not recovering in this regard fell with a patient's increasing expectations of recovering (odds ratio, 0.92), self-efficacy in managing chronic conditions (0.85), and optimism (0.87) at baseline; odds rose with each additional week elapsed since the injury (1.26).


"These results have important clinical implications as [low expectations of recovery and pain catastrophising] are modifiable through health education approaches," the authors wrote, noting that providing patients with information about the natural course of whiplash can help address both. Further, low expectations of recovery can be addressed with counselling and coaching strategies, and by answering questions to reduce uncertainty, and pain catastrophising can be addressed with psychotherapy and/or mindfulness training, and by providing education on pain and its management, they added.


The study was led by Yolanda Pedrero-Martin, PT, MSc, University of Malaga, Malaga, Spain, and was published online in the Clinical Journal of Pain.


Limitations included a lack of information on potential confounders (eg, medications, mental health status, and physical factors that could alter the trajectory of recovery) and a lack of objective outcomes.


This study was funded in part by the Spanish Agency of Science and Innovation. The authors reported no conflicts of interest.

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