Skip to main content
Emergency Medicine Journal : EMJ logoLink to Emergency Medicine Journal : EMJ
. 2002 Nov;19(6):526–530. doi: 10.1136/emj.19.6.526

Prevention of chronic pain after whiplash

R Ferrari 1
PMCID: PMC1756295  PMID: 12421777

Abstract

The acute whiplash injury is a significant health burden for patients and the healthcare system. Traditional approaches to treatment fail to resolve this ever growing medicolegal and social problem. A new biopsychosocial model of whiplash disorder encourages new ways of treating and preventing of the chronic disability. This biopsychosocial model takes into account the mechanism by which acute pain becomes chronic pain, and how this can be prevented. Specific education and treatments encourage a behaviour after whiplash injury that is conducive to more rapid recovery, and provides the whiplash patient with insight into the mediators of chronic pain. The article describes in practical terms how to use education, reassurance, a more judicious use of therapy, and exercise to achieve this goal. Practical guidelines are provided on educating the patient about other symptoms that may cause concern.

Full Text

The Full Text of this article is available as a PDF (211.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aubrey J. B., Dobbs A. R., Rule B. G. Laypersons' knowledge about the sequelae of minor head injury and whiplash. J Neurol Neurosurg Psychiatry. 1989 Jul;52(7):842–846. doi: 10.1136/jnnp.52.7.842. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Baer N. Fraud worries insurance companies but should concern physicians too, industry says. CMAJ. 1997 Jan 15;156(2):251-3, 256. [PMC free article] [PubMed] [Google Scholar]
  3. Barsky A. J. Amplification, somatization, and the somatoform disorders. Psychosomatics. 1992 Winter;33(1):28–34. doi: 10.1016/S0033-3182(92)72018-0. [DOI] [PubMed] [Google Scholar]
  4. Barsky A. J., Goodson J. D., Lane R. S., Cleary P. D. The amplification of somatic symptoms. Psychosom Med. 1988 Sep-Oct;50(5):510–519. doi: 10.1097/00006842-198809000-00007. [DOI] [PubMed] [Google Scholar]
  5. Borchgrevink G. E., Kaasa A., McDonagh D., Stiles T. C., Haraldseth O., Lereim I. Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident. Spine (Phila Pa 1976) 1998 Jan 1;23(1):25–31. doi: 10.1097/00007632-199801010-00006. [DOI] [PubMed] [Google Scholar]
  6. Cassidy J. D., Carroll L. J., Côté P., Lemstra M., Berglund A., Nygren A. Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med. 2000 Apr 20;342(16):1179–1186. doi: 10.1056/NEJM200004203421606. [DOI] [PubMed] [Google Scholar]
  7. Ferrari R., Kwan O., Russell A. S., Pearce J. M., Schrader H. The best approach to the problem of whiplash? One ticket to Lithuania, please. Clin Exp Rheumatol. 1999 May-Jun;17(3):321–326. [PubMed] [Google Scholar]
  8. Ferrari R., Leonard M. S. Whiplash and temporomandibular disorders: a critical review. J Am Dent Assoc. 1998 Dec;129(12):1739–1745. doi: 10.14219/jada.archive.1998.0144. [DOI] [PubMed] [Google Scholar]
  9. Ferrari R. Prevention of chronic pain after whiplash. Emerg Med J. 2002 Nov;19(6):526–530. doi: 10.1136/emj.19.6.526. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ferrari R., Russell A. S. Development of persistent neurologic symptoms in patients with simple neck sprain. Arthritis Care Res. 1999 Feb;12(1):70–76. doi: 10.1002/1529-0131(199902)12:1<70::aid-art11>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  11. Ferrari R., Russell A. S. Epidemiology of whiplash: an international dilemma. Ann Rheum Dis. 1999 Jan;58(1):1–5. doi: 10.1136/ard.58.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ferrari R., Russell A. S. Pain in the neck for a rheumatologist. Scand J Rheumatol. 2000;29(1):1–7. [PubMed] [Google Scholar]
  13. Ferrari R. The biopsychosocial model--a tool for rheumatologists. Baillieres Best Pract Res Clin Rheumatol. 2000 Dec;14(4):787–795. doi: 10.1053/berh.2000.0113. [DOI] [PubMed] [Google Scholar]
  14. Hoffman J. R., Mower W. R., Wolfson A. B., Todd K. H., Zucker M. I. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000 Jul 13;343(2):94–99. doi: 10.1056/NEJM200007133430203. [DOI] [PubMed] [Google Scholar]
  15. Keidel M., Rieschke P., Stude P., Eisentraut R., van Schayck R., Diener H. Antinociceptive reflex alteration in acute posttraumatic headache following whiplash injury. Pain. 2001 Jun;92(3):319–326. doi: 10.1016/S0304-3959(01)00272-X. [DOI] [PubMed] [Google Scholar]
  16. McKinney L. A. Early mobilisation and outcome in acute sprains of the neck. BMJ. 1989 Oct 21;299(6706):1006–1008. doi: 10.1136/bmj.299.6706.1006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Mittenberg W., DiGiulio D. V., Perrin S., Bass A. E. Symptoms following mild head injury: expectation as aetiology. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):200–204. doi: 10.1136/jnnp.55.3.200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Obelieniene D., Schrader H., Bovim G., Miseviciene I., Sand T. Pain after whiplash: a prospective controlled inception cohort study. J Neurol Neurosurg Psychiatry. 1999 Mar;66(3):279–283. doi: 10.1136/jnnp.66.3.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Partheni M., Constantoyannis C., Ferrari R., Nikiforidis G., Voulgaris S., Papadakis N. A prospective cohort study of the outcome of acute whiplash injury in Greece. Clin Exp Rheumatol. 2000 Jan-Feb;18(1):67–70. [PubMed] [Google Scholar]
  20. Pearson N. D., Walmsley R. P. Trial into the effects of repeated neck retractions in normal subjects. Spine (Phila Pa 1976) 1995 Jun 1;20(11):1245–1251. doi: 10.1097/00007632-199506000-00006. [DOI] [PubMed] [Google Scholar]
  21. Provinciali L., Baroni M., Illuminati L., Ceravolo M. G. Multimodal treatment to prevent the late whiplash syndrome. Scand J Rehabil Med. 1996 May;28(2):105–111. [PubMed] [Google Scholar]
  22. Radanov B. P. Epidemiology of whiplash. Ann Rheum Dis. 2000 May;59(5):395–396. [PubMed] [Google Scholar]
  23. Radanov B. P., Sturzenegger M., Di Stefano G. Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings. Medicine (Baltimore) 1995 Sep;74(5):281–297. doi: 10.1097/00005792-199509000-00005. [DOI] [PubMed] [Google Scholar]
  24. Spitzer W. O., Skovron M. L., Salmi L. R., Cassidy J. D., Duranceau J., Suissa S., Zeiss E. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine (Phila Pa 1976) 1995 Apr 15;20(8 Suppl):1S–73S. [PubMed] [Google Scholar]
  25. Stiell I. G., Wells G. A., Vandemheen K. L., Clement C. M., Lesiuk H., De Maio V. J., Laupacis A., Schull M., McKnight R. D., Verbeek R. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841–1848. doi: 10.1001/jama.286.15.1841. [DOI] [PubMed] [Google Scholar]
  26. Vendrig A. A., van Akkerveeken P. F., McWhorter K. R. Results of a multimodal treatment program for patients with chronic symptoms after a whiplash injury of the neck. Spine (Phila Pa 1976) 2000 Jan 15;25(2):238–244. doi: 10.1097/00007632-200001150-00016. [DOI] [PubMed] [Google Scholar]
  27. Williams M. M., Hawley J. A., McKenzie R. A., van Wijmen P. M. A comparison of the effects of two sitting postures on back and referred pain. Spine (Phila Pa 1976) 1991 Oct;16(10):1185–1191. doi: 10.1097/00007632-199110000-00010. [DOI] [PubMed] [Google Scholar]

Articles from Emergency Medicine Journal : EMJ are provided here courtesy of BMJ Publishing Group

RESOURCES