title: Pain avoidance predicts disability and depressive symptoms three years later in individuals with whiplash complaints.
abstract: BACKGROUND
  Longstanding symptoms due to whiplash are commonly associated with decreased levels of emotional and physical functioning. To date, there is strong empirical support for the relationship between psychological in/flexibility and pain-related functioning, but the predictive role for future health is largely unknown. Hence, the aim of this study was to investigate if psychological in/flexibility (i.e. avoidance and cognitive fusion) predicted pain disability and depressive symptoms 3 years later in individuals with whiplash complaints.
  
  
  METHODS
  Data were collected at baseline and at a 3 year follow-up from 368 members of a national patient organization for people with whiplash-associated disorder. In a series of hierarchical regression analyses, background variables, pain related variables, psychological distress and psychological inflexibility at baseline were evaluated as predictors of levels of pain disability and depressive symptoms at follow-up.
  
  
  RESULTS
  Results showed that psychological inflexibility, and more specifically avoidance, was a unique predictor of pain disability and depressive symptoms, also when controlling for background variables, pain related variables and psychological distress. Level of education was also found to predict both pain disability and symptoms of depression. Lastly, pain variability predicted pain disability, and anxiety predicted depressive symptoms.
  
  
  CONCLUSIONS
  Pain avoidance significantly predicted pain disability and depressive symptoms 3 years later. Although tentative, results warrant more studies to further explore the importance of pain avoidance for future health.
authors.affiliation: Behavioural Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden.|Department of Neuroscience, Uppsala University, Uppsala, Sweden.
authors.forename: V
authors.initials: V
authors.lastname: Zetterqvist
authors.affiliation: Behavioural Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden.|Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Holmström
authors.affiliation: Behavioural Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden.|Department of Psychology, Uppsala University, Uppsala, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Maathz
authors.affiliation: Behavioural Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden.|Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: R K
authors.initials: RK
authors.lastname: Wicksell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology; D003071:Cognition; D003863:Depression / Q000209:etiology* / Q000523:psychology*; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D011237:Predictive Value of Tests; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D014911:Whiplash Injuries / Q000150:complications* / Q000523:psychology*; D055815:Young Adult