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

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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.

Freeman dismisses the demolition-derby study as having nothing to do with the actual conditions under which car accidents occur. Similarly, he says that being struck from behind while totally unprepared is far different from being in the car that strikes another. He notes that he soon will publish a study showing that 45% of people with chronic neck pain were injured in a motor vehicle crash. "Some 6 million people are injured in U.S. car crashes every year -- 3 million of these are whiplash," he says. "Are you telling me all these people are crazy?" Freeman is assistant professor at the Oregon Health Sciences University School of Medicine.

Berry does not use the word crazy, but he says all this pain cannot be real. "It may be presented as severe pain, but often if you look at what these people can do in their lives you may find there is a disproportion," he says. "They are quite active and capable of doing many things except work."

Vital Information:

 

  • Whiplash is a neck injury that most often happens to drivers who are hit from behind, and 10% of these injuries cause lasting pain.
  • Some doctors believe that whiplash is a physical condition attributed to specific nerves inside the neck joint.
  • Others argue that whiplash is a combination of psychological factors and say doctors should try to prevent sufferers from becoming "chronic patients."
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