Preventing Chronic Whiplash Pain

This study is a step forward for those helping patients with whiplash. Instead of simply questioning whether chronic whiplash pain is real or not, these researchers tested two different treatment methods on a group of patients with new whiplash injuries to see which was more effective.

The study looked at 60 patients with whiplash injuries less than two months old, and divided them into two demographically similar groups. Group A received a multimodal treatment regimen that contained: relaxation training; active reduction of cervical and lumbar lordosis; psychological support to reduce anxiety and emotional upset; eye fixation exercises in order to prevent dizziness; and manual treatment (massage, mobilization) of the cervical spine. Group B patients received TENS and ultrasound treatment only.

The investigators studied cervical range-of-motion (ROM), reported pain, self-rated outcome, and time to return to work.

Results:

• Cervical ROM: There was no statistical difference between the two groups by the end of treatment, however "...patients from Group A showed a progressively increasing benefit, even after the interruption of treatment, in contrast to Group B subjects, whose recovery reached a plateau..."
• Pain reports: Both groups reported similar numbers of pain-free subjects at the end of the study. For those patients still in pain, though, Group A subjects reported a significantly lower level of pain (1.9 compared to 4.8 on a scale of 1 to 10).
• Self-Rated Outcome: Patients in Group A "showed a greater satisfaction" in recovery than did Group B patients.
• Return to Work: Probably one of the most important measurements, this is where Group A patients really showed the benefit. "...at the 6-month follow-up stage all patients but one from Group A were engaged in their usual occupation, as compared to 24 subjects out of 30 from Group B." On average, Group A subjects were back to work 16 days sooner than Group B patients - a significantly better response to treatment.

This study makes it clear that a multimodal approach to whiplash pain is more effective than just relying on mechanical treatments. Whiplash is a complex issue involving cognitive and psychological factors as well as physical factors, and when this is recognized, treatment progresses more rapidly.

Provinciali L, Baroni M, Illuminati L, Ceravolo MG. Multimodal treatment to prevent the late whiplash syndrome. Scandinavian Journal of Rehabilitation Medicine 1996;28:105-111.

 

 

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