Comprehensive Program Can Overcome Chronic Whiplash
Feb. 29, 2000 (Ithaca, N.Y.) -- About 10% of patients who suffer whiplash
injuries have chronic, severe neck pain, and many are unable to work or enjoy
normal activities. Dutch researchers report in a recent issue of Spine
that a four-week treatment program helped most participants regain normal
function and return to work. Most no longer even needed pain-relieving
The program, which is similar to that used in many U.S. pain management
clinics, includes physical therapy and exercise training, counseling, sports,
group therapy, and help from an occupational therapist. After completing it,
65% of patients were able to return to full-time work and 92% were able to work
at least half time, researcher Alexander A. Vendrig, PhD, tells WebMD. Before beginning the program, all 26 patients
had pain for at least six months after a whiplash injury, and all were at least
partially unable to work. Their average time out of work had been over a
Although Vendrig expected his program
to help patients get back to work, he tells WebMD that he was surprised to find
that more than half of them needed no pain relievers or other treatment (such
as physical therapy) after completing it. He suspects this is because the
comprehensive approach helps patients break bad "pain behavior" cycles
and regain normal function. For example, a patient recovering from whiplash may
avoid normal neck movement. This can cause muscle wasting and decreased blood
flow, which can lead to more neck pain.
Vendrig's program uses "graded
activity" to help patients learn new ways of moving and dealing with neck
pain. This can help correct bad habits and restore muscle strength and
The program includes education, and
sports such as swimming and squash to help build endurance and confidence. An
occupational therapist helps the patients plan their return to work and make
any changes needed in the workplace.
Joel R. Saper, MD, who reviewed the
study for WebMD, says the findings support a comprehensive approach to whiplash
treatment. "The patients in this study had whiplash-related problems for at
least six months, and a large percentage of them had beneficial responses to
this treatment program," Saper says. "That in itself is important, even
in a [pilot] study like this one." Saper is director of the Michigan
Head-Pain and Neurological Institute in Ann Arbor.
Whiplash is never a simple problem,
Saper says. It may involve spinal nerve roots, joints, soft tissue injury,
behavioral components, and emotional and psychological elements. Saper tells
WebMD that all of these areas should be considered, which is why
one-dimensional approaches to whiplash pain, such as pain-relieving injections,
often do not produce lasting improvement.
The promising results Vendrig reports
in the pilot study still must be confirmed in larger groups of patients.
Vendrig's program is now being compared to conventional whiplash treatment in a
larger clinical trial.
- Approximately 10% of patients with whiplash injuries suffer chronic, severe
neck pain and may be unable to work or participate in some activities.
- A four-week treatment program helped most participants return to work and
gain normal function. Many no longer needed pain medications.
- The pain-management program includes physical therapy, exercise training,
counseling, sports, group therapy, and occupational therapy.