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Excerpt
In the article, “Pain and Psychological Symptoms of Australian Patients With Whiplash” (Spine, 21:804-10, 1996), we reported that patients with chronic neck pain after whiplash injury exhibit a characteristic profile on the SCL-90-R psychological symptom checklist.1 As a part of further research in the field of whiplash-associated pain, we have continued to recruit and asses such patients. This letter outlines a comparison between the pain intensity and psychological distress of the inception cohort, reported in the previously mentioned article, and that of a second cohort of 100 patients.
All patients were referred to the Cervical Spine Research Unit in New Castle, Australia, for assessment of chronic neck pain (duration of <3 months) that resulted from a motor vehicle accident where they underwent assessment of their pain and psychological status. They graded the typical level of their accustomed pain over the preceding 2 weeks on a 100-mm visual analogue scale (VAS),2 where the left-hand end of the line (0 mm) represented “no pain” and the right-hand extreme (100 mm) represented “the worst pain that the patient could imagine.” Patients also completed a standard McGill Pain Questionnaire to describe their typical pain experience over the same period.3,4 A psychologist administered the SCL-90-R.1 The demographic data, pain measures, and psychological scores for the first cohort were compared with those of the second cohort (Table 1, Figure 1).
No significant differences were found in age distribution or sex ratio. There was a statistically significant difference between the cohorts with respect to the duration of symptoms. The median duration of pain before patients were seen at the Unit was longer for the first cohort than for the second. This may reflect increased awareness of and access to the Units' assessment service.
There were no clinically significant differences between the two cohorts with regard to VAS scores. Although there was a statistically significant difference between the mean VAS scores for “typical pain over the past two weeks,” this difference was not considered clinically significant (Table 1).
Across all SCL-90-R subscales the two cohorts' scores were remarkably similar (Figure 1). The only statistically significant difference was that the second cohort exhibited less hostility than the first cohort (Mann-Whitney U-test; P = 0.002). This difference was not dramatic. It might be ascribed to any of a number of factors, including the changing attitudes of the general, medical, and legal communities toward patients with whiplash.
The psychological profile of patients with chronic neck pain after whiplash injury is a reproducible phenomenon, still in need of an explanation.
