Whiplash – What to Do When the Pain Just Won’t Go Away
For anyone who has treated patients who had whiplash injuries they know that the pain associated with whiplash is somehow different from other types of neck pain. In the hundreds of patients I have treated who were experiencing from a whiplash injury, a disproportionately high number seem to develop chronic unremitting pain. Another characteristic of whiplash injury is that the original pain associated with a neck injury often spreads to nearby regions of the shoulders, arms or already down to the mid-back. In many whiplash patients, the pain unfortunately too often spreads throughout the body, leading to a condition known as chronic extensive pain syndrome.
Because whiplash injuries often include litigation, many doctors and particularly defense attorneys, have credited this chronic unrelenting pain associated with whiplash to the fact that patients often seek financial gain by litigation.
In my own practice, I have seen patients who continue to experience neck and extensive pain many years after their court case was settled and they received a settlement payment. This observation argues against litigation as the reason people develop long-term and extensive pain so often after whiplash injury.
There is growing evidence in the scientific literature that supports the idea that whiplash is in the rare kind of injury and that a meaningful number of people who have consistent this kind of injury will go on to develop long-lasting pain which spreads well beyond the original injury in the neck.
Researchers publishing in the medical journal Pain looked at nearly 1000 patients who were involved with motor means accidents and consistent a whiplash injury. They compared those patients who are involved litigation versus patients with whiplash who were not involved in litigation. The authors of this study concluded that persistent pain after motor means accident is shared already in those patients not involved in litigation. Their findings suggest that some physiological abnormality is likely responsible for the shared finding of persistent extensive pain following whiplash injuries that is unrelated to litigation.
Other researchers publishing in the journal Disability Rehabilitation looked at over 700 patients experiencing from posttraumatic neck pain. They found the nearly twice as many females versus male whiplash victims reported chronic extensive pain. They conclude that the high-frequency of regional and extensive 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 failed to correct the inner problem and leave a meaningful number of patients, particularly women, at risk for the development of chronic extensive pain symptoms.
The meaningful number of patients who develop chronic painful symptoms that often spread to the nearby regions of the body or to the complete body itself following injury to the neck indicates that whiplash trauma involves more than the muscles and joints of the neck itself. In fact, it indicates that patients that develop long-standing and extensive pain following a whiplash injury may truly have alterations in brain function.
To explain how changed brain function may rule to chronic and extensive pain, we need to delve into the neurological circuits that typically course of action pain and injury.
Think about the last time you stubbed your toe; there was an initial intense pain which quickly converts to a more achy and less intense set of symptoms. This is because at the moment of the initial impact, certain circuits that tell the brain the body has been injured are activated. The circuits from the edge, in our example the toe, ascend into the spinal cord up to the brain itself. When the signal reaches the brain you become aware that you damaged your toe. However that is not the end of the story. Shortly after you become aware that you have injured your toe, another neurological circuit is activated. This circuit descends from the brain back to the spinal cord and its purpose is to dampen or shut off the ascending pain signals.
This is a simplified example that explains why the intense pain of stubbing your toe soon becomes a more achy, throbbing sensation which while unpleasant, is much different than the original painful experience.
The bright idea here is that there is ascending “on-switch” for pain which sends pain signals from the body to the brain that also activates the descending pain “off- switch” to the spinal cord. This is how pain signaling in its simplest form is supposed to work.
Patients that develop long-standing chronic pain that doesn’t respond well to most forms of care, are believed to have impaired descending circuits that fails to turn off the pain signals traveling from the body to the brain.
If this failure of ascending inhibition of pain signals is harsh, it can spill over into nearby parts of the spinal cord and consequently cause pain sensations in parts of the body that were not originally injured.
Researchers publishing a review of literature in the journal Pain Physician looked at studies specifically addressing the issue of brain abnormalities in chronic pain states including patients experiencing from whiplash. What they found was that patients experiencing from chronic neck pain from in any case cause had brain abnormalities associated with pain processing. The researchers also found these abnormalities in pain processing were more apparent in patients experiencing from whiplash injury.
consequently the obtainable research indicates that chronic pain and particularly chronic pain following a whiplash injury consequence from an abnormal signal processing in the brain instead of the neck, muscles, joints, and ligaments originally injured at the time of the whiplash injury. This argues for a different kind of treatment than those commonly used to treat chronic post-whiplash pain.
Another group of researchers publishing in the Scandinavian Journal of Pain, use d a special kind of MRI examine to study the pain processing circuits in the brains of patients experiencing from chronic pain associated with whiplash injury. They furthermore took blood samples of these patients and tested for biomarkers of inflammation in the blood.
They found elevated levels of inflammatory markers in about one of 3 chronic whiplash sufferers. They further found pain processing signal abnormalities, particularly related to the application of cold, in the pain processing circuits of chronic whiplash patients.
There is a form of chronic pain called the Thermo-regulatory Disinhibition form of central pain. In this form (which is beyond the scope of this article) abnormalities in the peripheral pathways that deal with the ability to properly course of action cold sensations such as an ice bag applied to the skin, are associated with increased activity in those circuits related to pain processing.
In a nutshell, the ability to feel cold sensation suppresses the ability to feel pain at the brain level, consequently anything that alters the ability to course of action cold stimuli enhances the body’s processing of painful stimuli. Taken to the extreme, loss of ability to course of action cold signaling will rule to intense pain which is generated at the brain level. This is a shared finding after a patient has a stroke or spinal cord injury.
It provides a form however, which helps to explain why a substantial number of whiplash patients go on to develop chronic extensive pain. It also provides a treatment option, based on restoring normal cold sensation processing, which could have the effect of reducing pain signaling going to the brain.
This is a novel approach to the treatment of chronic pain following whiplash injury and represents a brain-based method to treat pain in the body that often fails to respond to traditional methods of rehabilitation.
There are a number of method and methods obtainable to attempt to restore normal cold signal processing that have been found to be abnormal in patients experiencing from chronic whiplash signs and symptoms. The restoration of cold signaling in the brain can directly attenuate the brain’s processing of painful stimuli.
These methods of treating pain by modulation of cold processing circuits in the brain, offer the first true breakthrough in chronic whiplash pain management in years. They are an exciting development for patients experiencing from chronic extensive post-whiplash pain.