Review of Chronic WhiplashThe authors of the studied reviewed sources of pain, treatment, and prognosis of cervical whiplash injuries. Whiplash describes the mechanism of injury and the associated neck pain caused by it. While soft tissues are usually the source of pain, chronic whiplash and associated pain may have other sources. The authors discussed facet joints, discs, and craniocervical ligaments as sources of chronic pain from whiplash injury. The authors report that clinical studies indicate that 15 percent to 40 percent of persons with acute neck pain after a motor vehicle crash will develop chronic pain. Five percent to seven percent will become permanently partially or totally disabled. Those who report acute neck pain immediately following the MVC are three times more likely to report chronic neck pain seven years later than those who did not have immediate onset of neck pain. Complete recovery in the studies reviewed by the authors is 60 percent to 85 percent. The authors found that the strongest predictor of poor outcome is high initial pain intensity. They also found that patients with better coping seem to have more functional outcomes than those that don't. Fear avoidance may contribute to the disability of the chronic pain. Baseline psychological factors, litigation, age, sex, and forces generated in the accident did not seem to be predictive of outcome.
Symptoms of whiplash include neck pain, pain in the trapezius muscle, shoulder, interscapular area, arm, and occasionally the face. Studies indicate that there may be a significant incidence of shoulder problems in patients with chronic whiplash. Pain can also be from nerve compression, discogenic or facetogenic sources. Headache is reported as the second most common symptom of whiplash. There are several documented sources for cervicogenic headache such as the C2-3, C3-4 discs, facet joints and the atlanto-occipital joint. Low back pain may occur in as many as 50 percent of whiplash patients, with 20 percent to 40 percent experiencing chronic low back pain. Cervical facet joints may cause chronic pain in 49 percent to 60 percent of patients. The evidence supporting discogenic pain is not as good, but seems likely as a source of chronic neck pain. Radiographic studies show that alar and transverse ligaments may be damaged by whiplash and when found on MRI were more common in patients with a history of whiplash. Patient symptoms and MRI findings did not correlate.
Patients who remained active despite pain fared better. At one year, patients treated with cervical immobilization had a higher incidence of neck pain and disability than those who did not. Exercise is effective pain treatment for chronic neck pain, however stretching is not. Exercise directed at strengthening of the neck and shoulder and upper back area can reduce pain and improve function. Exercise must be continued to maintain gains. Physical therapy may be beneficial initially, but studies show that the benefits may not be apparent at 12 months. Body mechanics training for home, work and recreation is shown to be beneficial. Spinal manipulative therapy results are conflicting.
The most useful drugs among studies were anti-inflammatories, opioids, and muscle spasm agents for up to 14 days after the accident.
Several studies indicate that up to 83 percent of patients report good to excellent results following anterior cervical fusion for axial neck pain following whiplash using the Oswestry Disability Index particularly.
Jerome Schofferman, MD et al. Chronic Whiplash and Whiplash-Associated Disorders: An Evidence-Based Approach. Journal of the American Academy of Orthopaedic Surgeons. October 2007. Volume 15. Pp. 596-606.
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