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Whiplash: Predicting Long-Term Problems


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June 25, 2001 -- Whiplash victims with the worst neck pain and stiffness immediately following their accident are more likely to remain disabled a year later, according to a new Danish study. Researchers could find no obvious physical cause for these patients' lingering problems.

"We can identify those people who are at risk of prolonged disability if we examine them in the week [following a wreck]," says study leader Helge Kasch, MD, PhD, from the department of neurology and the Danish Pain Research Centre at Aarhus University.

Kasch's team examined 141 adults who'd contacted local emergency rooms within two days of a car accident, complaining of neck pain or headache. All had been rear-ended in the crash but did not lose consciousness or suffer amnesia. None had prior neck or back pain, or a history of severe headaches.

By combining scores for neck pain and stiffness with those for other, nonpainful symptoms such as dizziness, nausea, and blurred vision, says Kasch, "we could identify those who were going to recover."

Generally speaking, "whiplash patients recover completely," he says. In fact, "99.2% of those with low preliminary pain and stiffness scores were better within a month. But "those who had reduced neck [movement] were at highest risk, and 75% of them were still handicapped after one year."

The pain and stiffness were completely subjective, as reported by the patients, says Kasch. And X-rays revealed no more tissue or structural damage in those with higher scores.

Interestingly, some factors believed important in whiplash recovery had no influence at all. Patients involved in an ongoing lawsuit regarding their accident, for instance, were no more or less likely to recover than those who were not.

"That's intriguing, because it goes against what we see every day," John Heller, MD, professor of orthopaedic surgery at Emory University School of Medicine in Atlanta. He was not involved in the study. "There are people we call symptom amplifiers who embellish their injuries."

That said, says Heller, "The absence of abnormality on an X-ray does not mean there's an absence of reason to hurt." In fact, recent studies have found tiny, pain-causing spine injuries that escaped even MRI and CT scans. "We know that violent accelerations of the head and neck cause injuries that leave aches and pains," he tells WebMD. "We just don't know how to find or fix them. Thankfully, most people get well."

Kasch says that all patients were more likely to report symptoms that the researchers mentioned again and again. "When we repeatedly asked them if they had neck or back pain, we saw significant increases. That means that somehow we may be making them more alert to those symptoms, if they are of low intensity," he says. Kasch did not suggest that the symptoms were imaginary.

Right now, Kasch tells WebMD, "there is no gold standard for the treatment of whiplash." That may soon change. "The findings may help bring about better approaches for treating these people" by enabling identification of those at greatest risk for ongoing disability, he says.

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