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The Development of Chronic Pain Conditions Following Whiplash Exposure

Patrick K Cronin¹, Madison N Cirillo², Alyssa L Schoenfeld³

¹Department of Orthopedic Surgery, Mass General Brigham, Harvard Medical School, Boston, MA.

|February 9, 2026

Abstract

Study Design:

Retrospective study.

Objective:

To determine the prevalence of new chronic pain conditions within one year of whiplash and the factors associated with chronic pain following whiplash exposure.

Summary Of Background Data:

Whiplash is among the most common injuries that occur following motor vehicle accidents. Many have postulated that whiplash is a progenitor for the development of chronic pain. Prior research in this arena has been limited.

Materials And Methods:

We retrospectively identified TRICARE beneficiaries who sustained a whiplash injury between 2017 and 2023. The records of eligible beneficiaries were abstracted to obtain age at the time of injury, race, sex, US census region, sponsor rank, mental health diagnoses, environment of care, beneficiary status, time period of injury, and number of comorbidities. We considered junior enlisted sponsor rank indicative of lower socioeconomic strata. The primary outcome was the development of a chronic pain condition. We used multivariable logistic regression with reweighting to account for confounders. We examined interactions between sex/mental health conditions, sex/socioeconomic status, and sex/time period to address secular trends.

Results:

The development of new chronic pain conditions occurred in 23.4%. After adjusting for confounders, we found that women (OR=1.57; 95% CI: 1.49-1.65), pre-existing mental health conditions (OR=1.35; 95% CI: 1.28-1.42) and our proxy for lower socioeconomic status (OR=1.15; 95% CI: 1.04-1.27) were significantly associated with the likelihood of developing chronic pain disorders within one year of whiplash injury. There were interactions between women and mental health conditions, as well as between women and socioeconomic status.

Conclusions:

This represents the largest study that longitudinally surveys the development of chronic pain conditions following whiplash. The incidence of chronic pain after whiplash is lower than has been previously postulated. We believe these findings can inform management during the postinjury time period and recommendations for surveillance.

Keywords:

chronic pain mental health conditions socioeconomic status universal health care whiplash injury

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