Role of pain coping strategies in prognosis after whiplash injury: passive coping predicts slowed recovery

Pain coping strategies are associated with pain severity, psychological distress and physical functioning in populations with persistent pain. However, there is little evidence regarding the relationship between coping styles and recovery from recent musculoskeletal injuries. We performed a large, population-based prospective cohort study of traffic injuries to assess the relationship between pain coping strategies and recovery from whiplash injuries. Subjects were initially assessed within 6 weeks of the injury, with structured telephone interview follow-up at 6 weeks, and 3, 6, 9 and 12 months post-injury. Coping was measured at 6 weeks using the Pain Management Inventory and recovery was assessed at each subsequent follow-up period, using a global self-report question. Multivariable Cox proportional hazards models showed that early use of passive coping strategies was independently associated with slower recovery. Depressive symptomatology (CES-D) was an effect modifier of this relationship. Without depressive symptomatology, those using high levels of passive coping recovered 37% slower than those using low levels of passive coping (HRR=0.63; 95% CI 0.44-0.91). However, in the presence of depressive symptomatology, those using high levels of passive coping recovered 75% more slowly than those who coped less passively (HRR=0.25; 95% CI 0.17-0.39). In other words, those with depressive symptoms but who used few passive coping strategies recovered four times more quickly than those with depressive symptoms who used high levels of passive coping. Active coping showed no independent association with recovery. These findings highlight the importance of early assessment of both coping behaviors and depressive symptomatology