title: Pain-related emotions in early stages of recovery in whiplash-associated disorders: their presence, intensity, and association with pain recovery.
abstract: OBJECTIVE
  Psychological factors such as depression affect recovery after whiplash-associated disorders. This study examined the prevalence of pain-related emotions, such as frustration, anger, and anxiety, and their predictive value for postcrash pain recovery during a 1-year follow-up.
  
  
  METHODS
  A population-based prospective cohort study design was used. Self-reported pain-related depression, anxiety, fear, anger, and frustration were assessed using 100-mm visual analog scales (VASs) at 6 weeks after crash in 2986 persons with traffic-related whiplash-associated disorder. Multivariable logistic regression was used to assess the relationship between the intensity of these pain-related emotions and pain recovery at 4 and 12 months after crash. Pain was measured at all time points on a 100-mm VAS, and pain recovery was defined as a score of 10 or lower.
  
  
  RESULTS
  Pain-related frustration was the most intense, with a mean score of 52. Only 3% of the cohort reported having no pain-related frustration, and 4% reported no pain-related anxiety. Multivariable logistic regression models revealed that each pain-related emotion increased the risk of failing to recover (odds ratios for each point increase on the 100-mm VAS), ranging from 1.011 to 1.015. Specifically, with each 10-point increase in pain-related emotion, the odds of failing to achieve pain recovery at 4 months was increased by 14% (p < .001) for depression, 15% (p < .001) for anxiety, 11% (p < .001) for fear, 12% (p < .001) for anger, and 11% (p < .001) for frustration.
  
  
  CONCLUSIONS
  These findings suggest that it may be beneficial for health care providers to address emotional status related to pain in the first few weeks after a whiplash injury.
authors.affiliation: Department Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada. lcarroll@ualberta.ca
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Carroll
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.forename: Lena W
authors.initials: LW
authors.lastname: Holm
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology; D000328:Adult; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000523:psychology*; D011446:Prospective Studies; D014911:Whiplash Injuries / Q000150:complications* / Q000534:rehabilitation*