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A Pain in the Neck -- Or Just a Pain?

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WebMD Health News

April 14, 2000 (Atlanta) -- "Car crash + whiplash = cold cash," a Canadian law firm advertises. But money can't explain the 10% of whiplash patients who suffer long-lasting neck pain -- and neither can doctors.

Whiplash is a neck injury that most often happens to people riding in cars that are unexpectedly struck from behind by another car. Most of these injuries get better fast, but about one in 10 patients has lasting pain -- and half the time this pain is so severe that it makes a person unable to work or enjoy a normal lifestyle. Dueling editorials in the journal Archives of Neurology show that experts differ greatly in the way they understand this chronic whiplash syndrome -- and in the way they treat their patients.

"It is hard to accept that the symptoms of whiplash are the result of an international, translingual conspiracy," write Nikolai Bogduk, MD, PhD, and Robert Teasell, MD, in their commentary. These authors argue that there is something physically wrong with whiplash patients who feel severe neck or head pain more than a year after their injury.

Bogduk, a researcher at the University of Newcastle in Australia, has conducted several studies of chronic whiplash patients suggesting that at least half the time, the pain comes from specific nerves inside the neck. To find out whether a patient has this kind of pain, it is necessary to inject a painkiller into the joint to see if the pain goes away. If it does, the patient can choose to have the nerve permanently deadened. So far, this is the only medically proven treatment for chronic whiplash syndrome. Bogduk and Teasell admit that people with chronic neck pain have more psychological symptoms than other people, but they say this is the result -- not the cause -- of their pain.

The exact opposite is the case, argues an accompanying commentary by neurologist Henry Berry, MD, of the University of Toronto. Berry says that by considering only physical explanations, doctors fail to understand that chronic whiplash syndrome is a combination of many things -- nearly all of which involve a person's state of mind.

"There are many doctors who [think that] if a patient comes to them with a disorder, there must be something wrong with them," Berry tells WebMD. "They take every symptom literally. Whereas if you step back, you see that these symptoms can be caused by life stress, the illness 'role' as a way of adjusting to life, psychiatric disorders, or even [made up by the patient]. This makes [the doctor's job] more difficult -- you have to make some difficult judgments, and some of your patients become unhappy with you because you tell them nothing is wrong and they want to be ill," he says.

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