Chronic pain after a car accident

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The accident is over. So why does it still hurt?

For many people, a car accident is the beginning of something much longer than the collision itself. There are appointments, unanswered questions, disrupted routines, and the uncertainty of not knowing when your body will feel like yours again.

Research estimates discussed in my conversation with pain management physician Dr. Dean Halmer suggest that roughly 40% to 60% of people with whiplash may develop ongoing symptoms. One systematic review also found that at least 31% of people injured in a motor vehicle collision reported lower back pain a year later.

Those numbers matter. But they do not tell us what any one person’s future will look like. What they tell us is that recovery deserves more attention than simply waiting for injured tissue to heal.

Pain after a car accident involves the body, the nervous system, our sense of safety, and the life we are trying to return to. Understanding that bigger picture can help us find a way forward without dismissing either the injury or the person experiencing it.

Key Takeaways

• Recovery after a car accident involves physical injuries, nervous system responses, psychological distress, and social circumstances.
• Early pain relief can make rehabilitation more accessible and help rebuild confidence in treatment.
• Gradual, individualized movement supports recovery without requiring people to force every painful activity.
• Persistent pain deserves reassessment and coordinated care rather than assumptions based on a fixed recovery timeline.

When Pain Relief Creates Room for Recovery

Dr. Hommer shared the story of a patient whose truck was left in multiple pieces after a devastating collision. When he first saw her, about three weeks after the accident, her pain was overwhelming.

At that point, the immediate priority was not a complicated explanation of chronic pain. It was helping her get enough relief to participate in treatment.

Drawing on his military experience, he used battlefield acupuncture, a technique involving small needles placed at specific points in the ear. He reported that her pain dropped from approximately nine out of ten to around two.

That is one patient’s experience, not a promise about how anyone else will respond. What matters here is the role that relief played: it created an opening.

When pain is consuming your attention, it can be incredibly difficult to learn something new, practise rehabilitation exercises, or imagine improvement. Reducing that intensity can make the next part of recovery more accessible.

Dr. Hommer described another benefit, too. Experiencing relief helped his patient believe that further treatment might be worthwhile. That belief did not repair all her injuries. It helped her engage with the work ahead.

Acute Pain and Chronic Pain Can Feel Similar

Acute pain usually serves a protective purpose. Touch a hot stove and you pull your hand away. Sprain an ankle and pain encourages you to change how you use it while the injury is assessed and begins healing.

After a collision, pain may reflect injured muscles, joints, nerves, or other tissues. Those biological problems deserve proper evaluation and treatment.

Persistent pain becomes more complicated. Pain can continue beyond the expected healing period, with changes in how the nervous system processes and responds to information. There may also be ongoing tissue or nerve problems. These possibilities are not mutually exclusive.

Dr. Hommer discussed a three-to-six-month window commonly used when talking about the transition to chronic pain. Definitions vary by context, although pain lasting or recurring for more than three months is widely classified as chronic.

But you do not necessarily feel a clear moment when acute pain becomes chronic. Yesterday’s pain and today’s pain may feel almost identical.

The important distinction is that pain intensity alone cannot explain everything happening in the body. Persistent pain requires a broader assessment, not an assumption that the original injury is either still fully active or completely irrelevant.

The International Association for the Study of Pain’s terminology offers helpful context: pain is a personal experience influenced by biological, psychological, and social factors.

Why Recovery Must Look Beyond the Injured Body Part

It makes perfect sense to think, “My knee hurts, so the problem must be my knee.” Sometimes there is a very specific knee injury that needs treatment. But after an accident, that may not be the whole story.

Consider someone who becomes anxious whenever they approach the intersection where the collision happened. Or someone who cannot bring themselves to drive to physiotherapy. The injury, the fear, and the practical barrier to treatment are now connected.

This is where a biopsychosocial approach becomes useful:

• Biological: What tissues, nerves, movement patterns, or other physical problems need attention?
• Psychological: How are fear, distress, expectations, and confidence affecting recovery?
• Social: Can the person access treatment, maintain relationships, and participate in everyday life?

None of this means the pain is imaginary. It means the person experiencing it is more complex than one scan or one injured structure.

Ask about the experience, not just the label

Dr. Hommer made a useful point about how we discuss anxiety. Asking, “Are you anxious?” may not open much of a conversation, particularly when someone feels uncomfortable seeking psychological support.

More specific questions can be easier to answer:

• Do you feel uneasy driving past the accident location?
• Are you avoiding driving because you worry it could happen again?
• Has getting to appointments become difficult?
• Are you missing family gatherings or spending more time alone?

His workplace offers transportation for patients who cannot comfortably drive themselves. That addresses access to care, but it may also provide a manageable step toward becoming more comfortable with travel again.

Psychological treatment can be part of pain care, too. Dr. Hommer highlighted cognitive behavioral therapy as an approach with research support for chronic pain. It belongs alongside physical care, not in place of taking physical symptoms seriously.

The Cycle of Pain, Fear, and Reduced Movement

One of the most difficult parts of recovery is knowing that movement matters while feeling frightened of what movement might do.

“I know I need to move, but it hurts” is not resistance. It is a real dilemma.

Dr. Halmer described a cycle in which pain leads to less movement, reduced movement contributes to further difficulties, and those difficulties reinforce the fear of moving.

Protective movement patterns can also create problems elsewhere. Think about limping after an ankle injury and then developing back discomfort. The original injury matters, but so does the way the rest of the body adapts around it.

Breaking that cycle does not mean forcing every painful movement. It means finding an appropriate starting point.

Start with what is possible

In the early stages, not every movement necessarily hurts equally. A rehabilitation professional can help identify movements and positions that are more tolerable while respecting the injuries involved.

If leaning backward causes sharp pain, for example, the starting point may not be repeated backward bending. Dr. Hommer described using an isometric exercise, where a muscle produces force without moving through the painful range, as one possible alternative.

The progression might involve:

1. Identifying movements that are currently tolerable.
2. Working within an appropriate range rather than forcing the most painful direction.
3. Addressing muscle tension and restricted movement.
4. Gradually expanding activity as symptoms and function allow.

That process gives the body practice, but it also gives the person experience. Each manageable step offers evidence that some movement is possible.

The goal is not to win an argument with pain. It is to rebuild capacity and confidence gradually.

Muscle Guarding, Sensitization, and the Nervous System

After a sudden impact, muscles may tighten protectively. Dr. Hommer explained this using the image of the body trying to stop an unexpected movement during a collision.

That protective response can remain part of the problem afterward. Muscles stay tense, movement feels restricted, and the person continues to feel guarded even though the immediate event has ended.

Depending on the assessment, treatment may include stretching, physical therapy, soft tissue techniques, or other approaches directed at pain and muscle tension. The purpose is to support a return to movement, rather than treating passive relief as the entire recovery plan.

Sensitization adds another layer. The nervous system can become more responsive, so that sensations or activities produce a stronger pain response than expected.

This is not something we can diagnose simply because pain has lasted a long time. It is one possible part of a broader clinical picture.

Complex regional pain syndrome is a specific condition

Dr. Hommer used complex regional pain syndrome, or CRPS, to illustrate how pain can involve more than the original injured area.

After an injury such as an ankle sprain, someone might develop marked sensitivity, difficulty tolerating a sock, pain extending beyond the ankle, or changes in skin appearance and hair growth. That is different from assuming every slow recovery is ordinary soreness.

CRPS requires clinical assessment. The National Institute of Neurological Disorders and Stroke’s CRPS resource provides further information about its symptoms and treatment.

Dr. Hommer also described using scalp acupuncture in his own practice for CRPS. That was an account of his clinical approach, not a universal treatment recommendation. The broader lesson is that persistent pain can involve nervous system changes as well as local injury.

Hope Matters, but It Is Not a Demand to Think Positively

Why do some people recover relatively quickly while others struggle?

There is no single answer. Dr. Hommer discussed factors explored in pain research, particularly low back pain research, including smoking, work satisfaction, anxiety, depression, and aspects of a person’s social circumstances.

He also described how previous trauma and distrust may influence someone’s willingness to engage with treatment. These factors are not a checklist that predicts an individual’s future. They are reasons to understand the person more fully.

Belief matters because it can affect whether treatment feels possible, credible, and worth attempting. If every appointment has been disappointing, another exercise plan may feel like one more thing that will fail.

That does not mean someone causes persistent pain by feeling discouraged. It means discouragement deserves care, too.

Hope is often built through experience: a reduction in pain, an appointment where someone feels understood, a movement that becomes easier, or a small return to normal life. It does not have to begin with certainty.

Recovery Timelines Need Context

Dr. Hommer often tells patients to expect generalized soreness during the first six to eight weeks after a collision. He sees many soft tissue problems improve with rehabilitation over that period.

That is a clinical expectation for many of the patients he treats, not a deadline everyone must meet.

It is also important to distinguish widespread aching from more specific problems that need investigation. Shooting pain down an arm, persistent focal knee pain, or symptoms associated with a significant shoulder injury may require a different assessment and treatment plan.

The patient whose truck was severely damaged had several overlapping problems, including nerve compression, knee pain, and a brain injury. Her care unfolded over time through rehabilitation, injections, and neurological rehabilitation.

That example matters because a whole-person approach does not mean overlooking structural injuries. Assess the biological problems, address concerning findings, and keep the psychological and social picture in view.

It also reminds us that one treatment rarely explains a complex recovery. Different needs may become clearer as the initial pain settles.

Participation and Connection Help Build a Way Forward

When I asked what his patients had taught him, Dr. Hommer returned to active participation in rehabilitation. He described the encouragement of hearing people say that the work they were doing was making a difference.

Then he identified something else: the social support that develops within a rehabilitation setting.

Someone just beginning treatment may meet another person who is further along. That conversation can make progress feel more believable. During his military career, he saw a similar connection when newly injured amputees met people several months into rehabilitation.

There is something powerful about knowing you are not the only person navigating this.

Recovery does not always mean erasing every ache. Dr. Hommer shared that he still experiences some pain related to a serious cycling collision in his youth, yet returned to active life after rehabilitation.

That is a hopeful distinction. Persistent symptoms do not automatically mean that a meaningful, active life is out of reach.

If pain has continued after a car accident, you deserve more than reassurance that everything should be fine by now. You deserve an assessment that takes your injuries seriously, rehabilitation that meets you where you are, and support for the fear and disruption that can come with the experience.

The whole picture matters. And within that bigger picture, there can be more room for recovery than it first appears.

Connect with Deana at Pain 2 Possibilities:

deana@pain2possibilities.com

Connect with Dr. Dean Hommer:

https://procareinjury.com/team/dean-hommer-md/