title: Potential processes involved in the initiation and maintenance of whiplash-associated disorders: discussion paper 3.
abstract: METHODS
  Nonsystematic review and discussion of the etiological processes involved in whiplash-associated disorders (WAD).
  
  
  OBJECTIVE
  To summarize the research and identify priorities for future research.
  
  
  BACKGROUND
  Although there is convergent evidence of a peripheral lesion in some individuals after whiplash injury, in the majority of injured people, a lesion cannot be established with current imaging technology. Therefore, it is important to consider processes that underlie the initiation and maintenance of whiplash pain as this may allow for the development and testing of interventions to target these processes and improve outcomes.
  
  
  METHODS
  A nonsystematic review was performed to summarize current knowledge regarding potential etiological processes involved in the initiation and maintenance of WAD and to identify future research priorities.
  
  
  RESULTS
  There are several etiological processes potentially involved in the initiation and maintenance of WAD. These include augmented nociceptive processing, stress system responses, and psychosocial and sociocultural factors. Recent findings also indicate that morphological changes in the neck muscles of injured people show some association with poor recovery, but the mechanisms underlying these changes are not clear. Preliminary evidence indicates associations between these processes. Future research priorities include the following: more sophisticated investigation and analysis of interactions between the various processes; whether the modification of these processes is achievable and if modification can improve health outcomes; and to clarify factors involved in the initiation of whiplash pain versus those involved in symptom maintenance.
  
  
  CONCLUSIONS
  Research to date indicates that there are several physiological and psychological etiological processes that may underlie the initiation and maintenance of whiplash-related pain and disability. Further research is required to determine relationships and interactions between these factors and to determine whether their modification is possible and will improve outcomes after injury.
authors.affiliation: Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Brisbane, Queensland, Australia. m.sterling@uq.edu.au
authors.forename: Michele
authors.initials: M
authors.lastname: Sterling
authors.forename: Samuel A
authors.initials: SA
authors.lastname: McLean
authors.forename: Michael J L
authors.initials: MJ
authors.lastname: Sullivan
authors.forename: James M
authors.initials: JM
authors.lastname: Elliott
authors.forename: Jan
authors.initials: J
authors.lastname: Buitenhuis
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kamper
mesh_terms: D004185:Disability Evaluation; D006801:Humans; D009334:Neck Muscles / Q000473:pathology / Q000503:physiopathology*; D019547:Neck Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D010147:Pain Measurement / Q000379:methods; D013315:Stress, Psychological / Q000209:etiology / Q000503:physiopathology*; D014911:Whiplash Injuries / Q000150:complications / Q000503:physiopathology*