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#Trauma does not occur in a vacuum. A thread.
Drawing inspiration from the recent release of the @Cause_Health book ("Rethinking Causality, Complexity, & Evidence for the Unique Patient," previous chats w/ folks like @RogerKerry1, my own clinical observations, findings from our collaborative research & others, I'm reminded
that people do NOT experience their trauma in a vacuum. The development of persistent symptoms following trauma (be it an ankle sprain, a motor vehicle crash, an assault, a slip-and-fall), is common and contributes substantially to societal and personal costs.
Existing classification systems are meant to function as a prognostic and intervention decision aids, but their usefulness has been questioned. Emerging evidence highlights the heterogeneity of MSK pain by demonstrating physical and psychological impairments that are unique to
those who develop persistent symptoms. These impairments are not recognized in most classification systems. The focus of our collaborative work is to identify how psycho- and neurobiological factors interact with and contribute to the development of chronic MSK pain and
are influenced by existing personal & environmental factors. Our work has been developed through over 20 years of work in the field, consultation w/ experts, extensive knowledge of existing evidence, & new evidence from our (cc @uwo_dwalton) own, & our collaborators, research.
A sub-theme is that a point of convergence currently exists between the psychological, physiological and social determinants of health literature that can further explain the complex presentation of chronic MSK pain. A start here https://bit.ly/2N2hcUn , BUT not a definitive end.
Our collaborative is proposed to orient future research towards more interdisciplinary efforts across non-traditional fields including data scientists and consumers to clarify the mystery of chronic pain/disability following trauma.
Let's look at #Whiplash, for example. There remains limited evidence for the clinical importance of most imaging findings. However, it is possible the type & number of findings on Computed Tomography (CT) may contribute to prognostic recovery models. https://bit.ly/30NqVpO
Of interest, it seems established crash parameters are not associated with the heterogeneity of #whiplash injury recovery. https://bit.ly/3fys0Wu
So, what gives? Why do some transition to chronic pain and others seem to recover spontaneously?
What about the brain? Well, here's a start... http://www.ajnr.org/content/41/6/994 .
Then there is this...increased pain in the absence of overt tissue-damage w/ evidence of spinal cord hypersensitivity
https://pubmed.ncbi.nlm.nih.gov/14715383/ & https://pubmed.ncbi.nlm.nih.gov/20594646/
Then there is this...increased pain in the absence of overt tissue-damage w/ evidence of spinal cord hypersensitivity
https://pubmed.ncbi.nlm.nih.gov/14715383/ & https://pubmed.ncbi.nlm.nih.gov/20594646/
More to come re: the cervical spinal cord and potential insults in some, not all.
What about pre-collision (or pre-trauma) health? Here's an interesting study - "Pre-collision Medical Diagnoses Predict Chronic Neck Pain Following Acute Whiplash Trauma" https://pubmed.ncbi.nlm.nih.gov/30829733/
In keeping with this, are differences in pain severity among acutely injured people related to the perceived stress of the traumatic event and pre-existing vulnerabilities? https://pubmed.ncbi.nlm.nih.gov/31833913/
How do we measure who is who and who is at risk?
Well we're getting better (much better) at identifying important factors around recovery...it ain't perfect, but it's a damn good start. https://pubmed.ncbi.nlm.nih.gov/25827122/
Some emerging evidence that a physiotherapist-led intervention of stress inoculation training & exercise can result in clinically relevant improvements in disability compared with exercise alone-the most commonly recommended treatment for acute WAD.
https://pubmed.ncbi.nlm.nih.gov/30661011/
https://pubmed.ncbi.nlm.nih.gov/30661011/
and that neck specific exercises can improve neck muscle endurance. https://pubmed.ncbi.nlm.nih.gov/26387858/
Time to get back to work as there's much to be done...in collaboration, recognising that people do NOT experience their trauma in a vacuum.
