Coping and recovery in whiplash-associated disorders: early use of passive coping strategies is associated with slower recovery of neck pain and pain-related disability

Clin J Pain. 2014 Jan;30(1):1-8. doi: 10.1097/AJP.0b013e3182869d50.


Objective: Coping is shown to affect outcomes in chronic pain patients; however, few studies have examined the role of coping in the course of recovery in whiplash-associated disorders (WAD). The purpose of this study was to determine the predictive value of coping style for 2 key aspects of WAD recovery, reductions in neck pain, and in disability.

Methods: A population-based prospective cohort study design was used to study 2986 adults with traffic-related WAD. Participants were assessed at baseline, 6 weeks, and 4, 8, and 12 months postinjury. Coping was measured at 6 weeks using the Pain Management Inventory, and neck pain recovery was assessed at each subsequent follow-up, using a 100 mm visual analogue scale (VAS). Disability was assessed at each follow-up using the Pain Disability Index (PDI). Pain recovery was defined as a VAS score of 0 to 10; disability recovery was defined as a PDI score of 0 to 4. Data analysis used multivariable Cox proportional hazards models.

Results: Those using high versus low levels of passive coping at 6 weeks postinjury experienced 28% slower pain recovery and 43% slower disability recovery. Adjusted hazard rate ratios for pain recovery and disability recovery were 0.72 (95% CI, 0.59-0.88) and 0.57 (95% CI, 0.41-0.78), respectively. Active coping was not associated with recovery of neck pain or disability.

Conclusions: Passive coping style predicts neck pain and self-assessed disability recovery. It may be beneficial to assess and improve coping style early in WAD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidents, Traffic
  • Activities of Daily Living / psychology*
  • Adaptation, Psychological
  • Adult
  • Canada / epidemiology
  • Causality
  • Comorbidity
  • Disability Evaluation
  • Disabled Persons / psychology
  • Disabled Persons / rehabilitation
  • Disabled Persons / statistics & numerical data
  • Female
  • Humans
  • Male
  • Neck Pain / epidemiology
  • Neck Pain / prevention & control*
  • Neck Pain / psychology*
  • Pain Management / methods
  • Pain Management / psychology*
  • Prevalence
  • Recovery of Function
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Whiplash Injuries / epidemiology
  • Whiplash Injuries / psychology*
  • Whiplash Injuries / therapy*