Study:  Expectancies Mediate the Relations Among Pain Catastrophizing, Fear of Movement, and Return to Work Outcomes After Whiplash Injury

Study: Expectancies Mediate the Relations Among Pain Catastrophizing, Fear of Movement, and Return to Work Outcomes After Whiplash Injury

Review by Yasmin Khalili

Study: Expectancies Mediate the Relations Among Pain Catastrophizing, Fear of Movement, and Return to Work Outcomes After Whiplash Injury


A great number of patients at our clinic suffer from whiplash-associated disorders following motor vehicle accidents that take away from their quality of life, comfort, and at times cause them to take prolonged time off work. Fear of movement and pain catastrophizing have proven to extend that duration of time that it takes for an individual to return to work post injury. The avoidance of movement based on fear and the exaggerated negative response to an unpleasant experience have been shown to result in greater disability for individuals suffering from whiplash, as well as many other injuries.

Having reasonable yet positive recovery expectancies are important as well, and past research has found that if a patient believes that they will never fully recover and return to work, then that will be their unfortunate result! At the same time, patients who expect to return to work are more likely to return to work. These results are strongly linked to each individual’s personal levels of fear of movement and pain catastrophizing.

We will review the study, and how this topic of whiplash and pain relates to our practice at CHANGEpain clinic below.

Publication Information: Carriere, J.S.; Thibault, P.; Milioto, M.; & Sullivan, M.J.L. Expectancies Mediate the Relations Among Pain Catastrophizing, Fear of Movement, and Return to Work Outcomes After Whiplash Injury. The Journal of Pain. Vol 16, No 12, 2015: pp 1280-1287.

Study Methods:

Participants: 154 individuals (consisting of 81 men and 73 women) who had suffered from whiplash and were on disability, all participants were working prior to their accident.

Procedure: Participants took part in a 7-week multidisciplinary rehabilitation program consisting of exercise, education, and self-management classes. Those who wished to take part in the study were invited to complete a questionnaire of self-reported measures of return to work expectancies, fear of movement, pain severity, and pain catastrophizing. Patients were contacted by telephone 1 year post completion of the rehabilitation program.

Measuring Pain Severity and Distribution: Pain was measured using the Pain Rating Index of the McGill Pain Questionnaire (MPQ-PRI) on the scale of 0 to 78, higher scores indicating increased levels of pain.

Measuring Pain Catastrophizing: Catastrophic thinking related to pain was measured using the Pain Catastrophizing Scale (PCS) on a scale of 0 to 52, with higher scores reflecting increased catastrophizing. Past research has shown that with higher PCS scores there is a lower chance of returning to work.

Measuring Return to Work Expectancies: Participants were asked to answer simple questions about how likely they believed it was for them to return to work within the next month with a percentage answer.

After 1 year of discharge, participants were contacted through telephone and asked whether they had been able to return to work, if they had been able to maintain their job, and the type of employment they were involved with, if any. Those who had returned to work by the time of the 1 year follow up and had been able to keep their position were classified as having successfully integrated work back into their lives.   


Women had significantly higher return to work expectancies than men, although the two did not have significant differences in their fear of movement, pain catastrophizing, and pain severity results.

At the 1 year follow-up 70% of women and 63% of men had successfully returned to work.

This study suggests that following a whiplash injury, return to work status is correlated to pain catastrophizing and fear of movement.


Significant positive relationship between pain catastrophizing and fear of movement was shown. The results also supported that return to work expectancies were significantly negatively correlated with pain catastrophizing and fear of movement. Lower scores of pain catastrophizing and fear of movement and higher scores on expectancies were strongly associated with the participants who had successfully returned to work.

Study Weaknesses:

As the 1 year interview was completed through telephone those who may have accepted to participate may have been better off than those to refused to take part, including language and cultural barriers. A $25 prize was given to all participants for completing the questionnaires before staring the rehabilitation program, however, it was unclear whether those who completed the phone interview had a monetary incentive as well.

Additionally, a number of the inclusion criteria, such as employment status pre-whiplash and participation in the entire rehabilitation program, were created to promote a stronger correlation in the final result.

Finally, return to work is determined by a host of factors, such as social, workplace, and economic, that were ignored in this study.

CHANGEpain Application:

At CHANGEpain clinic we have a multidisciplinary and layered approach to empowering our patients to change their pain. In addition to myofascial release and nerve block injections we offer a variety of classes to educate and build confidence within our patients, including classes teaching the foundations of movement with pain, the science of pain, and a series of psychology programs to support better mental health.

We strongly believe that for a patient to be able to successfully return to their life prior to living with chronic pain proper education and physician support is required.

For patients diagnosed with whiplash-associated disorders with offer MSP covered Whiplash Group Medical Visits as well.