Fear of movement in the early aftermath of a motor vehicle collision is an independent predictor of pain interference at six weeks

Persistent pain and associated disability after motor vehicle collision (MVC) is a common and costly problem. The fear-avoidance model hypothesizes that individuals with acute pain who have greater fear of movement (FOM) will have greater activity avoidance and will develop more severe persistent pain. In this prospective observational study, we investigated the influence of FOM on pain severity and pain interference six weeks after MVC. European Americans ≥18 and ≤65 years of age presenting to one of eight emergency departments (EDs) in four no-fault insurance states within 24 hours of MVC who did not have a fracture or other injury requiring hospital admission were enrolled. Baseline ED assessment included an evaluation of FOM (Tampa Scale for Kinesiophobia), current neck and overall pain intensity (each assessed on a 0-10 scale), and psychological symptoms and traits. Six-week telephone follow-up evaluation included an assessment of neck pain intensity, overall pain intensity, and pain interference (Brief Pain Inventory), which is an assessment of functional limitations resulting from the burden of chronic pain. 129 participants were enrolled and 125 (97%) completed six-week follow-up. FOM was significantly correlated with pain catastrophizing (r=.44) and expectations for physical (r=.22) and emotional (r=.20) recovery, but not with anxiety (r=.13), depression (r=.06), or peritraumatic distress (r=.08). FOM did not predict neck or overall pain severity at six weeks, but did predict pain interference (B = 0.66, p<.01). In a multivariable linear regression model adjusted for participant age, sex, and ED neck pain severity, FOM remained associated with pain interference six weeks after MVC (B = 0.50, p<.05). These results suggest that FOM has a specific effect on the impact of persistent pain on function. Further studies are needed to better understand the contribution of FOM to the development of persistent pain symptoms following MVC. Supported NIAMS R01AR056328.