Tell someone you have neck pain from whiplash and you are likely to be teased or accused of trying to get money from the insurance company. Our culture just doesn’t believe in these types of injuries.
Of course we didn’t really believe in head injuries either, and this denial has contributed to a number of football players with serious post-concussion brain problems. Now effort is being put into addressing the problem, including at the level of school sports.
Several studies have looked at recovery from whiplash, with predictably variable results. One of the better studies followed 50 patients seen at the emergency room for a whiplash injury, to see how well they recovered. Any patient with a fracture, ruptured disc or other serious injury was excluded. After two years, 30 percent of the patients had fully recovered, 40 percent had “nuisance” pain, 30 percent had “intrusive” pain, and 4 percent were disabled. In other words, 70 percent of them did not recover fully from their injury.
The researchers also wanted to see if people who don’t recover well from whiplash have underlying psychological problems. The patients were tested at the emergency room, and initial psychological tests were normal in most (82 percent) of the subjects. However, the tests became abnormal in 81 percent of the subjects who did not recover well and had chronic pain. In this study, the initial psychological tests did not help predict who would have a poor recovery.
The authors concluded that for most accident victims, psychological problems are the result of the accident, not the other way around. They also concluded that any compensation the patients received for their injuries did not usually meet the costs they incurred.
Other studies have shown very different outcomes; one interesting study of over 1,000 recent whiplash patients simply asked them to predict how well they would recover. Not surprisingly, those who gave themselves a better chance of recovery did recover better. Of course, patients with higher pain levels had lower expectations of a full recovery. Still, overall, an optimistic outlook on recovery made a difference.
One of the larger studies looked at 277 patients who were involved in legal action related to the crash, and also reviewed several previous efforts. Their conclusion was that the biggest factors that seemed to predict a poor outcome from a car accident were the severity of pain after the accident, pain radiating into the arm, and any symptoms of brain injury — forgetfulness, bad headache, “brain fog” etc. However, patients who had more visits to their family doctor in the five years previous to the crash, and those with a previous diagnosis of anxiety or depression, did not seem to recover as well.
It certainly makes sense that someone with a history of psychological or emotional problems will not recover as well from whiplash or any other injury. But whiplash produces very real physical trauma. Just because someone does not recover well does not mean they are reacting emotionally.
There is a tendency to lump everyone with chronic problems after a car crash into the same category as those who are looking for a settlement or seeking attention. This is simply not the case for many patients.
Next week I will cover the dynamics of a car crash, as well as best treatment options.
Dr. Michael Noonan practices chiropractic, acupuncture and other wellness therapies in Old Town. He can be reached at firstname.lastname@example.org.