Pain, pain catastrophizing, and autonomic nervous system dysfunction after traumatic injury: a prospective cohort study

Traumatic injuries from road traffic crashes are a major global health concern, resulting in significant physical, emotional, and social consequences, with pain being a frequent outcome. Chronic pain is often accompanied by maladaptive cognitive-emotional patterns, such as pain catastrophizing (PC) and autonomic nervous system (ANS) dysregulation, but their association with injuries remains largely unexplored. This study aimed to examine the impact of traffic-related injuries on pain, PC, ANS function, and their interrelationships. A prospective cohort of 120 adults with mild-to-moderate injuries and 112 non-injured controls completed assessments of pain and psychosocial outcomes (PC, post-traumatic stress, social participation) at baseline (3-6 weeks), 3, 6, and 12-months. ANS measures (heart rate and heart rate variability) were collected at baseline. At baseline, 58.3% of injured participants reported clinically relevant pain (≥4/10) versus 9.8% of controls (OR=12.85, 95% CI 6.3-26.4; RR=5.94; p<.0001), and 36.6% had elevated PC (≥12/52) versus 12.5% of controls (OR=3.5, 95% CI 1.8-6.6; RR=3.7; p<.001). ANS dysfunction was evident in the injury group compared to controls (p<.01). Over 12-months, repeated measures analyses showed higher pain, PC, post-traumatic stress, and lower social participation in the injury group compared to controls (p<.01), with pain and stress decreasing but remaining elevated. Elevated PC was associated with increased ANS dysfunction, regardless of injury, indicating maladaptive cognitive-emotional and physiological regulation and their combined influence on health and recovery. These findings highlight the importance of early integrated post-injury interventions targeting top-down cognitive processes and bottom-up physiological regulation to prevent chronic dysregulation and functional impairments.