A Pain in the Neck -- Or Just a Pain?
"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.
Both sides want to help their patients with chronic neck pain -- but their
approaches are very different. While Bogduk and Teasell recommend the neck
injection, Berry believes that extensive medical tests compound the problem.
"[The diagnosis you get depends] on the specialist you send patients
to," he says. "If you take these symptoms literally, you go on to
investigations that further the problems."
Berry, senior neurologist at St. Michael's Hospital in Toronto, says it is
important to tell patients who have recently suffered whiplash that their pain
will soon go away. He believes that it is extremely important to keep a person
from falling into the role of permanent patient, so he advises no more than two
weeks of physical therapy and sends people back to work as soon as possible.
"If a person is under a great deal of stress, he or she may realize
subconsciously that the illness 'role' is better than their life," he
Trauma expert Michael D. Freeman, PhD, thinks Berry is wrong. "The
contention that whiplash is not [a physical disease] can only be made if you
ignore the medical literature," he tells WebMD. "The idea that it is a
psychological disturbance is a myth that has been perpetuated with absolutely
no scientific basis at all."
Berry recently performed a study of demolition-derby drivers and found that
none had chronic neck pain -- despite a lifetime average of 1,600 whiplash
injuries. He also points out that, in court cases, far fewer plaintiffs than
defendants report chronic pain.