Acceptance: a factor to consider in persistent pain after neck trauma

Sophia Åkerblom; Johan Larsson; Eva-Maj Malmström; Elisabeth Persson; Hans Westergren

doi:10.1515/sjpain-2019-0021

Acceptance: a factor to consider in persistent pain after neck trauma

Scand J Pain. 2019 Jun 17;19(4):733-741. doi: 10.1515/sjpain-2019-0021. Print 2019 Oct 25.

Authors

Sophia Åkerblom^{1

2}, Johan Larsson^{1

3}, Eva-Maj Malmström^{1

4}, Elisabeth Persson¹, Hans Westergren^{1

5}

Affiliations

¹ Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.
² Department of Psychology, Lund University, Lund, Sweden.
³ Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.
⁴ Department of Clinical Sciences, Otorhinolaryngology, Skåne University Hospital, Lund University, Lund, Sweden.
⁵ Department of Health Sciences, Lund University, Lund, Sweden.

PMID: 31203263
DOI: 10.1515/sjpain-2019-0021

Abstract

Background and aims: Studies on the interaction between acceptance and pain-related processes after neck trauma are to our knowledge sparse and such treatment strategies are rarely incorporated in management and treatment of posttraumatic neck pain. Thus, the aim of the present study is to investigate how acceptance relates to persistent pain in patients after neck trauma, when controlling for the influence of other psychological factors, trauma characteristics and demographic variables.

Methods: Consecutive patients with persistent pain and disability after neck trauma (n = 565) were assessed by a multi-professional team at a specialized pain rehabilitation clinic. Separate regression analyses were conducted with three outcomes: pain distribution, pain interference, and pain severity. Predictors were age, sex, education, time since trauma, type of trauma, anxiety, depression, and acceptance.

Results: Acceptance was the only factor associated with all outcomes, and patients with lower acceptance displayed more widespread pain and greater interference and severity of pain. The results also showed that higher depression was associated with worse pain interference and severity, whilst anxiety only mattered significantly for pain severity and not for pain interference. Female sex was related to more widespread pain and greater pain interference.

Conclusions: Overall acceptance stood out as the most important factor for the different outcomes and lower acceptance was associated with more widespread pain distribution and greater pain interference and severity.

Implications: The findings of this study add to a growing body of literature confirming that the development of chronicity after neck trauma should be understood as a multidimensional process, best described by a biopsychosocial model. The results also suggest that psychological factors and especially acceptance might be important processes with implications for enhanced recovery after neck trauma.

Keywords: acceptance; anxiety; chronic pain; depression; neck pain; whiplash injuries.