The problem of crash-related pain

Road traffic crashes are highly prevalent and burdensome in Australia and Whiplash-Associated Disorders (WAD) are the most common crash-related injury not involving hospitalisation. While many people with WAD recover, 50% experience poor prognosis, with persistent pain, high disability and psychological distress being associated with increased health costs. Yet isolated neck pain after traffic injury is extremely rare. Low back pain is commonly co-occurring and psychological factors are strong predictors of future disability.
In Western Australia, 27% of crash-related compensation claims are responsible for 92% of costs, with physiotherapy being the most commonly funded treatment. Spine and neck soft tissue injuries are the most prevalent and costly, with new injuries costing the Insurance Commission of Western Australia (ICWA) $111.5 million in 2018. However, current management of neck and back pain in primary care is not always effective. For example, clinical guidelines for WAD emphasise reassurance, exercise, and early graded return to normal activity but treatments generally have small effects and non-guideline-consistent treatment is common. Moreover, attempts to address both physical and psychological risk factors through multidisciplinary care have produced small or non-significant effects in both WAD and chronic low back pain (CLBP), prompting suggestions that better tailoring and integration of treatment components is needed.
There is encouraging evidence that physiotherapy interventions targeting specific modifiable biopsychosocial risk factors can be highly effective. However, one of the challenges in helping people with pain following traumatic events such as traffic crashes, is that pain and trauma symptoms reinforce each other. People facing pain and psychological stress after their crash may therefore benefit from more tailored and integrated early interventions to help them on the road to recovery.