Picturing Chronic Whiplash
Whiplash-associated disorder (WAD) is a condition characterized by a collection of symptoms that can arise after the sudden back-and-forth movement of the head and neck—most commonly from motor vehicle collisions. It’s estimated that 2-3 million Americans experience whiplash each year and the current data suggests as many as half may continue to experience ongoing, chronic WAD symptoms lasting longer than a year. Unfortunately, there’s no clear way to identify which patient may be at elevated risk for chronicity but a 2022 study suggests it part of the answer may have to do with drawing a picture.
In the study, researchers provided 205 chronic WAD patients with electronic diagrams of the human body and asked them to draw or fill in where they feel pain on their body. The patients also completed a Neck Disability Index questionnaire. They repeated the process a year later. The research team identified an association between perceived pain and disability (from the questionnaire responses) and the degree to which the patient’s pain was widespread (from their drawings).
This widespread pain is indicative of central sensitization, which is described as greater sensitivity to pain, even stimuli that isn’t normally painful. The system in the body that relays pain signals to the brain is the nervous system, and these signals must pass through the neck. This suggests that a nerve injury or an injury that interferes with the nervous system’s function may be a driving risk factor for chronic WAD. Interestingly, a systematic review that looked at health data from more than 390,000 WAD patients found evidence that a third of grade II WAD patients show signs of nerve injury, which would classify them as grade III WAD and necessitate a more comprehensive treatment approach. Other risk factors for chronic WAD include high initial pain and disability, current low back pain at time of whiplash event, history of neck pain, new onset headaches, post-injury anxiety, and cold hyperalgesia (high sensitivity to cold).
Doctors of chiropractic are trained to assess patients with whiplash injuries and to provide a conservative treatment approach that not only addresses the patient’s pain and disability, but also to educate them on the importance of maintaining their usual activity as best they can and to reassure them that they can get better—both of which are important for reducing the risk for persistent, ongoing symptoms. If necessary, they will team up with allied healthcare providers to provide the patient with the best possible chance for a satisfactory outcome.