Why Women Have Double the Risk of Long-Lasting Neck Pain After Whiplash

Women are twice as likely as men to have long-lasting neck pain after whiplash, according to the results of a study published in the European Journal of Pain. The reason for this stark increase in risk couldn’t be explained by the researchers however, although they did find a range of factors that increased the likelihood of ongoing chronic neck pain in both men and women.

Carstensen et al. recruited 740 men and women in Denmark who had experienced a car accident and who had sought medical assistance at an emergency department or their general practitioner. These participants completed questionnaires on collision characteristics, psychological distress, and socio-demographics within 5 days of their accident, the Coping Strategies Questionnaire at 3 months after their accident, and a neck pain intensity assessment using a Visual Analog Scale at 12 months post-collision.


The researchers were interested in discerning any gender-based differences in coping after whiplash, and the potential impact of gender on recovery after a car accident. What they found was the women had an odds ratio of 2.17 for long-lasting neck pain, but there appeared to be no differences between men and women when it came to the impact of coping strategies on neck pain.

Coping Strategies and Neck Pain After Whiplash

What they did find, however, was that several types of coping strategy were associated with a slight increase in the risk of considerable neck pain being an issue. These strategies (and their odds ratio) included:

• Distraction (OR 1.03)
• Reinterpreting (OR 1.03)
• Catastrophising (OR 1.14)
• Praying and hoping (OR 1.10)

Of these, ‘catastrophising’ and ‘praying/hoping’ had a clinically relevant influence on likely neck pain after whiplash, meaning that anyone working with those who has suffered this type of injury would do well to identify patients using such coping strategies and find ways to offer alternative management techniques.

Why Praying Away the Pain Might Not Help

It may be assumed that those whose main coping strategy is to pray or hope that things get better may not be actively engaged in physical therapy or other ways of restoring good health after whiplash. They may also avoid medical assistance more than those who are proactive about getting better. Similarly, those who catastrophise may anticipate not getting better at all, thereby reducing the impact of any therapies and/or engagement with such therapies for whiplash and whiplash associated disorder.

As we have reported previously on the PainNeck.com blog, counselling appears to help as much as physical therapy when it comes to treating whiplash. This may be because counselling after a car accident gives people better coping strategies and can avoid catastrophising and praying/hoping that things get better. As for the reasons behind gender differences in long-term whiplash associated neck pain, these scientists offer no additional insights, but it may be that multiple factors are at play here.

Why Men and Women Report Pain Differently

For one thing, women tend to report higher levels of pain in general, possibly due to less stigma associated with pain, and increased sensitivity to pain due to more concentrated nerve fibres in women compared to men – in fact, women have twice as many nerve fibres per square centimetre of skin than men (34 vs. 17). Many women return more quickly to everyday chores after injury, including household tasks like doing laundry, vacuuming, cooking, and childcare, which could mean that they have less opportunity for rest and recuperation after whiplash than their male counterparts.

There may also be a reporting effect in this study as it has been shown that (presumably heterosexual) men tend to report lower levels of pain when interviewed by women, perhaps because of a desire to appear macho. Women, meanwhile, tend to report higher levels of pain when interviewed by men as they may, understandably, expect to not be taken seriously otherwise.

Age and Gender – Their Effect on Neck Pain

The age of the women may also be relevant as oestrogen has a pain dampening effect and so any study involving postmenopausal women may find higher levels of pain compared to those involving younger women. As such, gender differences in neck pain after whiplash are likely not as simple as saying that women have twice the risk of long-lasting neck pain but, instead, involve a complex interplay between multiple factors.

References

Carstensen TB, Frostholm L, Oernboel E, Kongsted A, Kasch H, Jensen TS, Fink P. (2012). Are there gender differences in coping with neck pain following acute whiplash trauma? A 12-month follow-up study. Eur J Pain. 2012 Jan;16(1):49-60.