The mind matters when it comes to recovering from the pain of a whiplash injury, the results of a small study suggest.

In fact, researchers found that among 43 collision victims with whiplash, the duration of patients’ pain was more dependent on psychological factors than on the severity of the crash. These factors, such as how much attention a person tends to pay to bodily symptoms, were predictive of whether patients had pain that lasted for days or for weeks to months.

The implication is that it’s not the nature of the whiplash injury itself that determines who goes on to have chronic pain, study co-author Dr. Robert Ferrari of the University of Alberta Hospital in Edmonton, Canada, told Reuters Health.

Instead, he said, patients’ response to the injury, including whether they stop all activities, strap on a neck brace or rely on “passive” therapies like medication and massage rather than exercise, may be the key factors.

Ferrari and his colleagues report the findings in the May issue of the Journal of Neurology, Neurosurgery and Psychiatry.

Whiplash is an injury to the neck’s soft tissue, including muscles, ligaments and discs, which typically occurs during a car accident that sends the head and neck suddenly forward and back. Symptoms include neck pain and stiffness, headache, shoulder pain and dizziness.

When it comes to developing chronic pain, according to Ferrari, research suggests that the risk also varies widely by culture.

That’s not to say that when whiplash patients develop persistent pain it isn’t real physical pain, the researcher stressed.

But, he said, long-term pain may arise from “choices” patients make based on their view of whiplash, which, Ferrari said, may be “culturally determined.”

For example, he noted, research shows that whiplash patients in the U.S., Canada and many other Western nations commonly report chronic pain, while in certain countries, Germany, Greece and Lithuania, most patients recover quickly. There is evidence that an important difference between the two groups of nations is people’s beliefs about whiplash.

Ferrari said his own research has found that in North America, about half of people surveyed expected that if they were to suffer whiplash, chronic pain would follow. In Germany, Greece and Lithuania, that number was closer to five percent.

“It is the culture, not the crash, that is important,” Ferrari said.

The new study looked at whiplash patients treated at a German trauma center. Patients completed a standard psychological assessment shortly after the injury and again six months later. The researchers also collected information on patients’ symptoms, the severity of the crash, X-ray findings and treatment.

They found that the initial psychological assessment, and not crash severity or X-ray findings, predicted the duration of patients’ pain.

But Ferrari said that what was striking to him was how well these German patients did overall. Nineteen percent had symptoms that lasted for more than a month, while the majority felt better in less than a week. Treatment consisted of non-steroidal anti-inflammatory medications for one third of the patients and, for eight people with severe neck pain, a few days wearing a hard neck brace.

In Germany, Greece and Lithuania, he said, “the vast majority think of [whiplash] as an injury that will go away in days to weeks, and in fact, in these countries they seek little therapy for the problem when it occurs.”

Exactly why a German whiplash patient and a Canadian one would have a different mindset about the whiplash is unclear, according to Ferrari. He said the next step is to figure out the role of cultural factors, such as media messages.

SOURCE: Journal of Neurology, Neurosurgery and Psychiatry, May 2004.