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Whiplash: What Predicts Recovery?

Pain Level, State of Mind Important; Neck Collars Not Helpful, Research Shows
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Other Predictors of Recovery

Those prone to catastrophic thinking also fare poorly, Walton found in his analysis of 14 studies.

"These are the people who can't get the pain out of their mind, who believe this is the worst thing that has ever happened to them," he says.

Feeling down or blue immediately after a whiplash injury is common, says Leah Phillips, a PhD student and researcher at the University of Alberta, Edmonton, Canada. The depressed feeling is more likely to persist in those under age 50 with less education and income, she found in a survey of nearly 5,500 adults in Saskatchewan who had suffered whiplash injuries between 1997 and 1999.

Those who had more initial neck pain and low back pain, as well as higher levels of anxiety right after the injury, were also more likely to keep reporting the depressed feeling during the one-year follow-up, she says.

She wasn't measuring true clinical depression, she says, but asked at each follow up whether the patients had a depressed mood. "It could develop into clinical depression," she says.

Whiplash Treatment: Neck Collar Treatment Not Helpful

Wearing a neck collar to immobilize the area after whiplash injury is outdated, says Sylvia Schick, MD, MPH, a researcher at the Institute for Legal Medicine at Ludwig Maximilians Universitat in Munich, Germany.

Many physicians still prescribe the device, Schick says, but her comparison study of those who wore the collar with those who did not shows it is not useful.

Using the data base of a large insurance company in Germany, Schick and her colleagues compared the results of 31 whiplash patients treated without a neck collar and 40 with the neck collar. Both groups got about the same length and quality of treatment, she says, although those treated with the collar were also more likely to get pain-killing drugs.

No differences were found between groups in reports of neck pain or stiffness, she says. Those who wore the collar actually were absent longer from work than those who did not wear it. One study limitation, says Schick, was lack of information about how long the collars were worn.

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