Association Between Diagnostic Imaging, Medication Intake, and Health Outcomes in Chronic Whiplash-Associated Disorders: An Observational Study

Purpose: Studies have demonstrated that medication and diagnostic imaging (DI) use and, more broadly, health care resource utilization, are not necessarily concordant with clinical practice guidelines. However, these studies did not evaluate the concurrent presence of clinical manifestations. This study therefore aimed to investigate the association between medication intake and DI, and health outcomes including pain, disability, physical, and mental health-related quality of life in people with chronic whiplash-associated disorders (WADs). We also aimed to evaluate whether medication intake and DI use differed based on specific presenting clinical manifestations (pain classification category [nociceptive, nociplastic, or neuropathic], psychologic features, pain cognitions, and sleep). Method: This cross-sectional study investigated people attending a multidisciplinary chronic pain centre in Calgary, Canada, between October 2019 and December 2021 who attended for evaluation of chronic symptoms arising from a motor vehicle collision. Participants completed a series of questionnaires that evaluated various health domains (pain intensity/interference; disability; physical and mental health-related quality of life; depression, anxiety, and stress; post-traumatic stress; pain catastrophizing; and sleep) at intake, and anonymized results were entered into a registry database with their informed consent. Results: Different classes of medication intake, use of multiple medications, receiving computed tomography, ultrasound or magnetic resonance imaging scans and multiple DI utilization were associated with worse health outcomes. Increased medication intake was also associated with increased DI utilization. In concert, these results suggest that increased health care resource utilization was associated with worse health outcomes – both physically and psychologically – in chronic WAD. Conclusions: Our results indicate that medication intake and DI were not matched to clinical manifestations, and thus further education of health care providers is warranted to assist with appropriate health care resource utilization. These results also suggest that chronic WAD guidelines are required inclusive of recommendations for appropriate utilization of medication and referral for DI.