{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:16:24Z","timestamp":1791537384777,"version":"4.3.4"},"reference-count":45,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,1,26]],"date-time":"2018-01-26T00:00:00Z","timestamp":1516924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The objectives of the current study were to investigate (1) the longitudinal, reciprocal associations between pain and post\u2010traumatic stress symptoms as proposed by the mutual maintenance model, and (2)\u00a0\u00a0to assess the predictive value of the three clusters of post\u2010traumatic stress, where the model revealed that post\u2010traumatic stress symptoms maintained pain in a consecutive cohort of whiplash\u2010injured.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Participants (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0253; 66.4% women) were people with\n                      <jats:styled-content style=\"fixed-case\">WAD<\/jats:styled-content>\n                      grades I\u2013\n                      <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n                      following motor vehicle crashes in Australia. Pain and post\u2010traumatic stress symptoms were assessed by questionnaires over the course of a year (at baseline (&lt;4\u00a0weeks), 3, 6 and 12\u00a0months post\u2010injury). The objectives were tested using auto\u2010regressive cross\u2010lagged modelling and two additional structural equation\u00a0models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analyses revealed that post\u2010traumatic stress symptoms at baseline predicted an increase in pain between baseline and 3\u00a0months and that post\u2010traumatic stress symptoms at 6\u00a0months predicted an increase in pain between 6 and 12\u00a0months, beyond the stability of pain over time. Furthermore, hyperarousal at baseline significantly predicted pain at 3\u00a0months and hyperarousal at 6\u00a0months significantly predicted pain at 12\u00a0months with 16 and 23% explained variance, respectively. [Correction added on 2 March 2018 after first online publication: the explained variance for hyperarousal symptoms at 6 months was previously given incorrectly and has been corrected to 23% in this version.]<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results point to a temporal main effect of post\u2010traumatic stress symptoms on pain over and above the stability of pain itself within the first 3\u00a0months post\u2010injury and again in the chronic phase from 6 to 12\u00a0months with hyperarousal symptoms driving these effects. From 3 to 6\u00a0months, there was a slip in the maintenance patterns with no cross\u2010lagged effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>\n                      Investigating mutual maintenance of pain and\n                      <jats:styled-content style=\"fixed-case\">PTSS<\/jats:styled-content>\n                      in whiplash, the present study found evidence suggesting a maintaining effect of\n                      <jats:styled-content style=\"fixed-case\">PTSS<\/jats:styled-content>\n                      on pain within the first 3\u00a0months post\u2010injury and from 6 to 12\u00a0months driven by hyperarousal, highlighting the importance of addressing\n                      <jats:styled-content style=\"fixed-case\">PTSS<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  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