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    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 warns.

    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.

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