I just started working in an orthopedic clinic with patients who have had car accidents. Most of them have some kind of neck or back pain. They are supposed to fill out a survey with information about their health. There are questions about alcohol and other drug use. We also ask about previous number of car accidents and past history of neck or back pain. Is there any way to tell if the information is really accurate? It seems like this would be important information to have when planning our treatment protocol.

You ask a very important question, especially in light of the fact that studies show a past history of neck or back pain is a strong risk factor for poor outcomes. Depression, drug abuse, and alcoholism are known to be linked with prolonged illness and pain severity.

Likewise, a history of mental health problems is also a risk factor for poor prognosis. Patients with a history of depression, anxiety, or bipolar disorder fall into this category.

Patients may not be deliberately misleading you with the information they provide. They may be distracted by the current accident when filling out the paperwork. As a result, they may forget important information about their health. To protect themselves, they may fail to report the use of alcohol or other drugs before, during, or after the accident.

The question of validity and accuracy of patient self-report after motor vehicle accidents has been brought up. Researchers at Stanford University School of Medicine have done some preliminary work in this area. What they found supports your suspicions. Up to 68 per cent of patients denied the presence of any of these risk factors.

Getting an accurate assessment of risk factors is important when setting up an effective treatment program. Preventing future accidents is important both in terms of personal and societal costs. More research is needed in this area.

Eugene J. Carragee, MD. Validity of Self-Reported History in Patients with Acute Back or Neck Pain After Motor Vehicle Accidents. In The Spine Journal. March/April 2008. Vol. 8. No. 2. Pp. 311-319.

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