Whiplash: What To Do When The Pain Just Won’t Go Away
Lifestyle FashionAnyone who has treated patients who sustained whiplash injuries knows that the pain associated with whiplash is somewhat different from other types of neck pain. In the hundreds of patients I have treated who suffered from whiplash injury, a disproportionately high number appear to develop unremitting chronic pain. Another characteristic of whiplash injury is that the original pain associated with a neck injury often extends to nearby regions of the shoulders, arms, or even the mid-back. Unfortunately, in many whiplash patients, the pain too often spreads throughout the body, leading to a condition known as chronic widespread pain syndrome.
Because whiplash injuries often involve litigation, many physicians, and defense attorneys in particular, have attributed this unrelenting chronic pain associated with whiplash to the fact that patients often seek financial gain through the litigation.
In my own practice, I have seen patients continue to experience neck pain and general pain many years after their court case settled and they received a settlement payment. This observation argues against litigation as the reason people develop widespread and long-term pain so often after a whiplash injury.
There is increasing evidence in the scientific literature to support the idea that whiplash is a unique type of injury and that a significant number of people who have sustained this type of injury will develop lasting pain that extends well beyond the original pain. . neck injury.
Researchers publishing in the medical journal Pain looked at nearly 1,000 patients who were involved in car accidents and sustained a whiplash injury. They compared patients who are involved in litigation versus whiplash patients who were not involved in litigation. The authors of this study concluded that persistent pain after a car accident is common even in those patients who are not involved in litigation. Their findings suggest that some physiologic abnormality is likely responsible for the common finding of persistent widespread pain after whiplash injuries that is unrelated to litigation.
Other researchers publishing in the journal Disability Rehabilitation looked at more than 700 patients suffering from post-traumatic neck pain. They found that almost twice as many female whiplash victims than males reported widespread chronic pain. They conclude that the high frequency of regional and generalized pain among patients with persistent neck pain after trauma requires a multidisciplinary approach to treatment. What these findings suggest is that traditional treatments for whiplash injuries often fail to correct the underlying problem and leave a significant number of patients, particularly women, at risk of developing chronic widespread pain symptoms.
The significant number of patients who develop chronic painful symptoms that often spread to adjacent regions of the body or to the entire body after a neck injury suggests that whiplash trauma involves more than the neck muscles and joints in Yeah. In fact, it suggests that patients who develop prolonged, widespread pain after whiplash injury may actually have impaired brain function.
To explain how altered brain function can lead to chronic and widespread pain, we must delve into the neurological circuits that normally process pain and injury.
Think about the last time you stubbed your toe; there was initial intense pain that quickly develops into a more painful and less intense set of symptoms. This is because at the moment of the initial impact certain circuits are activated that tell the brain that the body has been injured. Circuits from the periphery, in our example the toe, travel up the spinal cord to the brain itself. When the signal reaches the brain, you realize that you damaged your toe. However, that is not the end of the story. Shortly after realizing that you’ve injured your toe, another neurological circuit kicks in. This circuit descends from the brain to the spinal cord and its purpose is to dampen or turn off upward pain signals.
This is a simplified example that explains why the intense pain of stubbing your toe soon turns into a more painful, throbbing sensation that, while unpleasant, is very different from the original painful experience.
The bright idea here is that there is an ascending “on switch” for pain that sends pain signals from the body to the brain that also activates the descending “off switch” for pain to the spinal cord. This is how pain signaling in its simplest form is supposed to work.
Patients who develop prolonged chronic pain that does not respond well to most forms of care are thought to have impaired downstream circuitry that does not shut down pain signals traveling from the body to the brain.
If this failure to upstream inhibition of pain signals is severe, it can spread to adjacent parts of the spinal cord and thus cause pain sensations in originally uninjured parts of the body.
Researchers who published a review of the literature in the journal Pain Physician reviewed studies that specifically addressed the problem of brain abnormalities in chronic pain states, including patients suffering from whiplash. What they found was that patients suffering from chronic neck pain from any cause had brain abnormalities associated with pain processing. The researchers also found that these pain processing abnormalities were more evident in patients suffering from whiplash injuries.
Therefore, the available research suggests that chronic pain, and in particular chronic pain following whiplash injury, is the result of abnormal signal processing in the brain rather than the neck, muscles, joints, and muscles. the ligaments originally injured at the time of the whiplash injury. This argues for a different type of treatment than those commonly used to treat chronic post-whiplash pain.
Another group of researchers, publishing in the Scandinavian Journal of Pain, uses a special type of MRI to study the pain-processing circuitry in the brain of patients suffering from chronic pain associated with whiplash injuries. Rather, they took blood samples from these patients and analyzed biomarkers of inflammation in the blood.
They found elevated levels of inflammatory markers in approximately one of the 3 chronic whiplash patients. In addition, they found pain signal processing abnormalities, particularly related to cold application, in the pain processing circuitry of chronic whiplash patients.
There is a model of chronic pain called the thermoregulatory disinhibition model of central pain. In this model (which is beyond the scope of this article), abnormalities in peripheral pathways that deal with the ability to adequately process sensations of cold, such as an ice pack applied to the skin, are associated with increased activity in circuits related to pain processing. .
Simply put, the ability to feel the sensation of cold suppresses the ability to feel pain at the brain level, therefore anything that alters the ability to process cold stimuli improves the body’s processing of painful stimuli. Taken to the extreme, the loss of the ability to process cold signaling will lead to intense pain that is generated at the brain level. This is a common finding after a patient has a stroke or spinal cord injury.
However, it does provide a model that helps explain why a considerable number of whiplash patients develop chronic widespread pain. It also provides a treatment option, based on restoring normal processing of cold sensation, which could have the effect of reducing pain signaling to the brain.
This is a novel approach to the treatment of chronic pain after whiplash injury and represents a brain-based method of treating pain in the body that often does not respond to traditional methods of rehabilitation.
There are a number of means and methods available to attempt to restore normal cold signal processing that has been found to be abnormal in patients suffering from signs and symptoms of chronic whiplash. Restoring cold signaling in the brain can directly attenuate the brain’s processing of painful stimuli.
These methods of treating pain through modulation of cold-processing circuits in the brain offer the first major breakthrough in the treatment of chronic whiplash pain in years. They are an exciting advance for patients suffering from chronic widespread post-whiplash pain.