Background & Aims

Neck pain experienced after a motor vehicle crash (MVC) is usually termed ‘whiplash injury’ or ‘whiplash-associated disorder’ [1-2]. The term ‘whiplash’ is controversial due to perceived connotations that it may trigger negative thoughts and potentially influence recovery expectations [3-6]. Previous studies suggest that diagnostic labels for non-traumatic shoulder, low back, and hip pain influence people’s beliefs in managing the condition [7-10]. However, the influence of diagnostic labelling on recovery expectations and management preferences for traumatic neck pain following a MVC remains unclear.
This study aimed to (1) investigate whether different labels for neck pain following a MVC influence people’s recovery expectations and management beliefs (e.g. intention to make a claim), (2) understand reasons when recovery expectations are low and claim is intended, and (3) explore the moderating effects of neck pain status and sociodemographic characteristics.

Methods

This was an online-randomised, five-arm, parallel group experiment with a nested qualitative content analysis. 2,229 general public participants (age: 46.7 years [SD: 15.5]; 72.4% females; 66% reported previous or current neck pain) read a scenario describing a patient with neck pain following a MVC. The scenario used one of the five labels to describe the neck pain: whiplash injury, whiplash-associated disorder, post-traumatic neck pain, neck pain, and neck strain. Participants rated (0-10): recovery expectations (primary outcome), need for a second opinion, need for imaging, avoidance of work and physical activity, need for intensive treatments, perceived injury seriousness, anxiety about the given diagnosis, and intention to lodge a claim. Participants with lower recovery expectations (scored 0-5) and greater claim likelihood (scored 3-10) provided free-text responses about their reasons.

Results

Participants allocated to whiplash-associated disorder or neck pain labels had lower recovery expectations than those allocated to neck strain (adjusted mean difference [95%CI]: -0.5 [-0.9 to -0.1] for both comparisons). Participants assigned to whiplash-associated disorder more frequently expressed uncertainty about achieving full recovery while participants assigned to neck pain most commonly questioned the healthcare provider’s approach. There were also differences between labels in perceived need to avoid physical activity, receive intensive treatments and a second opinion, perceived injury seriousness and claim intentions. Participants allocated to the neck strain label felt less need for healthcare financial support and were less inclined to claim than those allocated to whiplash-associated disorder or whiplash injury. Neck pain status and household income moderated the labelling effects on recovery expectations and claim intentions, respectively. However, all effects were small.

Conclusions

Labels for neck pain after a MVC influence people’s recovery expectations and management preferences, but as the effects of diagnostic labels on these features were small, they may have little clinical relevance.

References

[1] Barnsley L, Lord S, Bogduk N. Whiplash injury. Pain. 1994;58(3):283-307.
[2] Spitzer WO. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining” whiplash” and its management. Spine. 1995;20:1S-73S.
[3] Bostick GP, Ferrari R, Carroll LJ, Russell AS, Buchbinder R, Krawciw D, et al. A population-based survey of beliefs about neck pain from whiplash injury, work-related neck pain, and work-related upper extremity pain. European Journal of Pain. 2009;13(3):300-4.
[4] Ferrari R, Russell AS. Correlations between coping styles and symptom expectation for whiplash injury. Clin Rheumatol. 2010;29(11):1245-9.
[5] Littlejohn GO, Guymer EK. Whiplash: Same Elephant, Different Room. The Journal of Rheumatology. 2014;41(3):411.
[6] Tanaka N, Atesok K, Nakanishi K, Kamei N, Nakamae T, Kotaka S, et al. Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury. Advances in orthopedics. 2018;2018:4765050.
[7] Haber T, Hall M, Dobson F, Lawford BJ, McManus F, Lamb KE, et al. Effects of Hip Pain Diagnostic Labels and Their Explanations on Beliefs About Hip Pain and How to Manage It: An Online Randomized Controlled Trial. J Orthop Sports Phys Ther. 2023;53(11):673-84.
[8] O’Keeffe M, Ferreira GE, Harris IA, Darlow B, Buchbinder R, Traeger AC, et al. Effect of diagnostic labelling on management intentions for non-specific low back pain: A randomized scenario-based experiment. Eur J Pain. 2022;26(7):1532-45.
[9] Zadro JR, O’Keeffe M, Ferreira GE, Haas R, Harris IA, Buchbinder R, et al. Diagnostic Labels for Rotator Cuff Disease Can Increase People’s Perceived Need for Shoulder Surgery: An Online Randomized Controlled Trial. J Orthop Sports Phys Ther. 2021;51(8):401-11.
[10] Zadro JR, O’Keeffe M, Ferreira GE, Traeger AC, Gamble AR, Page R, et al. Diagnostic labels and advice for rotator cuff disease influence perceived need for shoulder surgery: an online randomised experiment. J Physiother. 2022;68(4):269-76.

Presenting Author

Yanfei Xie

Poster Authors

Yanfei Xie (PhD)

PhD

RECOVER Injury Research Centre, The University of Queensland, Queensland, Australia

Lead Author

Nathalia Costa (PhD)

Lead Author

Anne Söderlund (PhD)

Lead Author

Joshua Zadro (PhD)

The University of Sydney

Lead Author

Eva-Maj Malmström

Lead Author

Genevieve Grant (PhD)

Lead Author

Gwendolen Jull (PhD)

Lead Author

Hans Westergren (PhD)

Lead Author

Helge Kasch (PhD)

Lead Author

Joy MacDermid (PhD)

Lead Author

Julia Treleaven (PhD)

Lead Author

Michele Curatolo

University of Washington

Lead Author

Sophie Lykkegaard Ravn and PhD

Department of Psychology, University of Southern Denmark, DK

Lead Author

Tonny Andersen

University of Southern Denmark

Lead Author

Trudy Rebbeck

PhD

John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia

Lead Author

Michele Sterling

RECOVER Injury Research Centre, The University of Queensland, Queensland, Australia

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Neck Pain