Early management of whiplash injuries may reduce chronic neck pain and disability

Dec 20 2011

New approaches to early management of whiplash injuries are needed to reduce the high percentage of patients who go on to develop chronic neck pain and disability, according to a special article in Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The special "Roundtable" article—part of a Spine supplement devoted to the topic of whiplash—highlights the need for effective, research-proven approaches to early management of whiplash injuries. "The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management," writes an expert panel led by Gwendolen Jull, PhD, of The University of Queensland, Australia.

Can Early Treatment Prevent Acute Whiplash from Becoming Chronic?
Whiplash is a very common type of neck injury, typically caused by rear-impact traffic crashes. Studies consistently show that neck pain and other symptoms of acute whiplash injury clear up within a few months in about half of patients. The other half have continued pain and disability one to two years later, with up to 20 percent having moderate to severe pain.

Early management may have a critical impact on the long-term outcomes of whiplash. Many different approaches have been tried, ranging from exercises, to immobilization, to acupuncture, to electromagnetic fields. None of these treatments has been convincingly shown to reduce the risk of whiplash symptoms becoming a chronic problem.

To address this issue, Dr. Jull and a multidisciplinary group of professionals took part in an "expert debate and synthesis of research" on treatment for acute whiplash. Their goal was to outline plans for developing more effective strategies for early management of whiplash, based on "biological, psychological, and social perspectives."

A New Agenda for Whiplash Research
An important starting point is the development of a triage system for early management. Because initial symptoms of whiplash vary significantly, it would be helpful if early factors associated with better or worse long-term outcomes could be identified. For example, in addition to severe pain, the prognosis may be worse for patients with headache, very limited neck movement, and psychological distress. Early identification of these factors might help to guide appropriate treatment for the individual patient.

The Roundtable participants also urge research into new approaches addressing the pain, physical, and psychological symptoms of whiplash. They suggest a systematic research agenda addressing four key areas:
•Education.—Research to identify the most effective ways of communicating accurate "information, assurance, and education" to patients in the acute phase of whiplash injury.
•Early pain management.—Studies to see if effective pain management can improve long-term outcomes, particularly in patients with more severe pain who are at higher risk of chronic whiplash symptoms.
•Physical rehabilitation.—Studies assessing the most effective approaches to physical rehabilitation after whiplash injury, focusing on reducing the rate of transition to chronic whiplash.
•Psychological rehabilitation.—Equally important, research into the psychological factors that can hinder recovery, and how best to manage them.

The Roundtable participants hope their research agenda will provide a firm foundation of knowledge for developing effective strategies for managing whiplash—especially in the acute phase after injury. They conclude, "Future high-quality clinical trials are needed to test the impact of new strategies on the rate of transition to chronicity," Dr Jull and coauthors conclude.

The special supplement to Spine also includes other articles and reviews of interest to physicians, surgeons, physical therapists, and other professionals involved in the evaluation and management of patients with whiplash. In addition to a new research study on the beneficial (or harmful) effects of early management, topics include the ways in which stress and financial compensation may influence the long-term outcomes of whiplash injury.