Chronic Whiplash Syndrome

Researchers writing in the Journal of Neurology say Botulinum toxin was not proven effective in treatment of neck pain in chronic whiplash syndrome.

Padberg M, de Bruijn SF, Tavy DL. Neck pain in chronic whiplash syndrome treated with botulinum toxin. A double-blind, placebo-controlled clinical trial. J Neurol. 2007 Mar;254(3):290-5. Epub 2007 Mar 7.

OBJECTIVES: Neck pain in chronic whiplash syndrome is a major burden for patients, healthcare providers and insurance companies. Randomized data on treatment of botulinum toxin in chronic whiplash syndrome are scarce. We conducted a randomized, placebo-controlled clinical trial to prove efficacy of botulinum toxin for neck pain in chronic whiplash syndrome.

METHODS: 40 patients with chronic whiplash syndrome (whiplash associated disorders grade 1 and 2) were randomly assigned to receive botulinum toxin (maximum 100 units) or placebo (saline) in muscles with increased tenderness.

RESULTS: After 12 weeks there was no significant difference between the two treatment groups in decrease of neck pain intensity on VAS (-7.0 mm, 95% confidence interval (CI) [-20.7 to +6.7]), mean number of neck pain days (-1%; 95% CI [-15% to +13%]), neck pain hours per day (-0.14; 95% CI [-3.0 to +2.7]), days on which symptomatic treatment was taken (-0.7%; 95% CI [-15% to +13%]) number of analgesics taken per day (-0.14; 95% CI [-0.6 to +0.4]) and total cervical range of motion (-11 degrees; 95% CI [-40 to +17]). There also was no significant difference in patient’s assessment of improvement after week 4, 8 and 12.

CONCLUSIONS: Botulinum toxin was not proven effective in treatment of neck pain in chronic whiplash syndrome. Increased muscle tenderness alone might not be the major cause of neck pain in whiplash syndrome.

Whiplash Injury and Back Pain Treatment

Discussions from our Radio Show:

Question: In whiplash, doesn’t it take a week to develop. Would you suggest painkillers or Prolotherapy?

Dr. Darrow: Well neither of those actually, NSAIDS block the Inflammation, the natural healing process, I would not do Prolotherapy for about 3-4 weeks after the injury to see how much natural healing takes place on its own without my interference. People usually stay inflamed for a few weeks, if the inflammation doesn’t go away then we use Prolotherapy techniques to help reinflame the area, get more blood flow to the area and create a healing situation.

Everybody has different effects, there are many types of risk factors for whiplash, one is being female. More females get injured more than men because I believe it is due to the fact that the musculature around the neck is smaller and not as strong in females so they get more of a whip. Age is also important, the older a person is the more of a chance of getting a whiplash with lasting disability, previous medical history with neck pain is also a factor, position in the vehicle is very important if some one has their head turned that is a different type of whiplash. Another thing is awareness, being prepared for the crash. If someone sees the car coming in the rearview mirror, they tighten up and that actually helps prevent whiplash, if some one is unprepared, their neck is very loose and there is more of a whip like injury.

Whiplash Symptoms and Treatment Options

Discussion from our Radio Show:

CALLER: My question is, I was in an accident and sustained injuries in the neck area, can you explain whiplash to me?

Doctor Darrow: A big problem is that people drive with their head restraints too low. So when they are rear-ended, their heads are thrown back violently while their car keeps moving forward.

In whiplash, your neck is kind of in an S-shape, when your head comes forward when your car stops, there is a sheer force on the vertebrae that can actually tear the vertebral end plates where the vertebrae attach to the discs and tear ligaments and sometimes you can’t see this on X-rays or MRIs it is very subtle thing that can happen, certainly x-rays don’t show it at all.

So it is an injury to the structures that hold up the head and that can be the ligaments, the parts of the muscles that attach to the bones, it can be the discs themselves, you can get disc herniation like that. And there are so many different side effects that can come from this, neck pain to headaches, some people get allergy type symptoms, they get GI complaints where there stomach is inflamed, anxiety problems, even depression. Some people even get Fibromyalgia which is just a syndrome, people get widespread pain. Fibromyalgia can be set off by a car accident.

Many times doctors do not find what they call objective findings, when they look at diagnostic studies, they don’t find anything at all, except that these people have a lot of misery.

Whiplash throughout the years has been laughed at by a lot of doctors. In the 19th century when people rode on the railways, they use to bounce against each other (because of the coupling system) and they use to wind up with whiplash, they called it Railway spine and they laughed at that.

What we are finding now is that even with low speed type car accidents, about 30-60% of these people end up with long lasting injuries, and about 35-50% of them never recover.

Whiplash

Discussions from our Radio Show:

Doctor Darrow: “The sad thing about whiplash is that people don’t think it is real and it can obviously cause neck pain, but, it can also cause pain anywhere in the body and a lot of this pain may not come out for months with strange seemingly unrelated symptoms like indigestion, fatigue, dizziness, a whole myriad of things and a large percentage of the people who get whiplash, and whiplash doesn’t just mean that you got hit from behind in a car, you can get whiplash from playing tennis or falling down, get these symptoms.

So whiplash is something that needs to be treated quickly and aggressively. With a new injury there is a certain window of opportunity to treat the injury and get it healed quickly, if treatment does not begin within that window, things can get chronic and sometimes life-long.