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