INTEGRATIVE PAIN CENTRE
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Whiplash (1)
What is whiplash injury? Whiplash injury is defined as “an
acceleration-deceleration” mechanism of energy transferred to the neck usually
as a result of a motor vehicle accident. (2)
How common is the problem? Whiplash injury is common after
traffic collisions. There maybe as many as 200-300 per 100,000 in the population
seen at the emergency department every year for this problem. (3)
What are the clinical presentations after whiplash injury? The onset of pain can occur
immediately after the accident or may be delayed for up to 12 hours. Patient would usually complain of neck
pain, neck stiffness, headache, shoulder pain and arm pain. Other common complains include
tiredness, dizziness, light-phobia, pain over the temporomandibular
joint and back pain. Psychologically, some patients may
develop post-traumatic stress disorder and insomnia. There maybe some association between the level of psychological
distress and the continuation of the symptoms after whiplash injury. Approximately up-to one third of
those with whiplash injury will develop into a complex presentation. These include widespread pain in the
neck region and also in the lower limbs, marked loss of neck movement, spinal
cord hyperexcitability and non-responsiveness to
standard physical therapy such as exercises. (4)
What are the pathophysiology /changes associated
with whiplash injury? What happens to the body after a
whiplash injury is not entirely clear.
There appeared to be changes in various parts of the body to result in
the final clinical presentation after a whiplash injury. Firstly, there is evidence that the
cervical spine structure is affected, especially at the facet joints. Also there are changes in the sensory system which augment the way pain is perceived by the
brain. In addition, there are disturbance in muscle function and its control,
which explain the reason of loss of balance and dizziness in some patients. (5)
How is whiplash injury diagnosed and treated? The diagnosis of whiplash injury is
based on patient self-report of symptoms. There are no diagnostic criteria for
whiplash injury. Imaging studies is also not useful in the majority of the
cases except in cases with suspected fracture or dislocation. Treatment of whiplash injury would
involve education of patient, reassurance and instructions to maintain
activity levels. It is critical
to prescribe functional exercises to maintain range of motion and also for
muscle re-education. Psychological support is important
especially for patient who had developed post-traumatic stress disorder or
chronic whiplash injury. In selected cases, interventional procedure
such as facet joint radiofrequency neurotomy may be
offered. (6)
What is the long-term outcome after whiplash injury? Most recovery after whiplash injury
occurs within the first 3 months.
The recovery tends to plateau after that. The most consistent predictor of poor
recovery is high level of initial pain and /or disability. Unfortunately a large proportion of
patients with whiplash injury (can be up to 60%) still developed persistent
mild to severe neck pain and /or disability. For more information, please feel
free to contact us at (65) 6733 4344 or email us at integrativepaincentre@gmail.com |
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