Comprehensive Program Can Overcome Chronic Whiplash

From the WebMD Archives

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 drugs.

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 year.

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 endurance.

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.

Vital Information:

  • 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.