Neck Solutions Blog

August 20, 2010

Late Sequelae of Whiplash Injury with Dissection of Cervical Arteries

Filed under: Whiplash — Administrator @ 4:17 am

Late Sequelae of Whiplash Injury with Dissection of Cervical Arteries.

From: Eur Neurol. 2010 Aug 18;64(4):214-218. [Epub ahead of print]

The objective of this study was to estimate the incidence of posttraumatic dissections of cervical arteries in patients with whiplash injury acquired in a car accident. The authors performed a retrospective analysis of medical records of 500 patients with whiplash injury acquired in car accidents between 1996 and 2005 and searched for dissections of cervical arteries occurring within 12 months after injury. Eight cases of cervical arterial dissection occurred within 12 months following whiplash injury. In 7 cases (87.5%), the dissection was complicated by brain infarction. The incidence of posttraumatic dissections after whiplash injuries was much higher than the overall incidence of cervical arterial dissections in the general population. The risk of cerebrovascular events was still increased 4-12 months after whiplash injury vs. the general population.

There is an increased risk of posttraumatic dissection and cerebrovascular events within 12 months after whiplash injury. Car accident is an important risk factor for arterial dissections. The victims of car accidents should be screened for arterial dissections. The results of this study should be more thoroughly investigated in a prospective trial of car accident victims as a risk factor for arterial dissections.

August 5, 2010

Identifying predictors of early non-recovery in a compensation setting: The Whiplash Outcome Study

Filed under: Whiplash — Administrator @ 1:02 pm

Identifying predictors of early non-recovery in a compensation setting: The Whiplash Outcome Study.

From: Injury. 2010 Jul 31. [Epub ahead of print]

People with Whiplash Associated Disorder often experience pain and disability for extended periods of time. A large proportion of these people will seek treatment through a compensation process. Rarely is data related to people’s health collected within the compensation process making it difficult to identify those that are at risk of delayed recovery and appropriately direct interventions.

To compare people with whiplash associated disorder who have recovered with those that have not, within 3 months of injury and identify potential predictors of poorer health and non-recovery to inform claim screening processes. People who sustained a whiplash associated disorder and claimed compensation within an Australian Motor Accidents Compensation Scheme between November 2007 and June 2009 participated in the study.

Recovery indicated by Functional Rating Index score less than or equal to 25. Outcome measures were Short Form 36 (SF36), FRI, and the Pain Catastrophising Scale. 246 people who had lodged a claim for compensation were enrolled in the Whiplash Outcome Study within 3 months of sustaining a whiplash associated disorder injury. Participants were assigned to a recovered or non-recovered group and analysed for differences between the two groups. Multiple linear regression models were used to identify potential predictors of poorer health and non-recovery.

Overall 23% of the study population had recovered within 3 months of sustaining a whiplash associated disorder, while only 9% had finalized their insurance claim. The recovered group had significantly better scores on all health outcome measures; SF36 Physical Component Score, SF36 Mental Component Score and the Pain Catastrophising Scale. The significant independent predictors of poorer health and non-recovery were helplessness, older age and pre-injury work status being affected. Regardless of the health outcome measure used, helplessness was significantly associated with poorer reported health.

Including additional information at claim notification, specifically the Pain Catastrophising Scale and information on the effect the injury has on the working population could significantly improve claim screening processes, identifying those with poorer health and risk of non-recovery.

Related Sources:

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July 21, 2010

Maintaining a balance: a focus group study on living and coping with chronic whiplash-associated disorder

Filed under: Chronic Pain,Neck Pain,Whiplash — Administrator @ 4:22 am

Maintaining a balance: a focus group study on living and coping with chronic whiplash-associated disorder.

From: BMC Musculoskelet Disord. 2010 Jul 13;11(1):158.

Whiplash was defined in 1995 by the Quebec Task Force as a neck injury mechanism and may result in injuries within the musculoskeletal and /or neurological system. The Quebec Task Force developed a system for grading Whiplash Associated Disorders : whiplash associated disorders I-II (symptoms without known pathology), III (symptoms and neurological signs), and IV (symptoms and cervical fracture and/or dislocation).

Grade I and II patients represent up to 90 % of “whiplash injury claims”. The proportion of patients who reports pain and disability six months after the accident (i.e. chronic whiplash associated disorders) varies substantially between studies and countries. However, a recent review suggests that approximately 50% of the patients with whiplash associated disorders will report neck pain symptoms one year after their injuries. Patients with chronic whiplash associated disorders report high levels of neck pain, headache, and shoulder pain often accompanied by neck stiffness, dizziness, fatigue, sleeping problems, concentration problems, allergy, breathing disorders, hypertension, cardiovascular disorders, digestive disorders, depression, anxiety, and impairment in cognitive performance. A recent study of a large population-based cohort of victims of car accidents, found that isolated neck pain was rare and that pain from multiple body areas was most commonly reported.

Expectations and coping styles might influence the outcome and prognosis after whiplash injuries. The Cognitive Activation Theory of Stress describes stress response as a general normal, healthy, and necessary alarm. There may be a risk of illness and disease only if the arousal is sustained. The level and duration of the alarm depends on the expectancy of the outcome of stimuli, as well as the results from specific responses available for handling the situation. Therefore, the cognitive activation theory of stress model emphasizes the importance of coping as positive response outcome expectancies. This means that if the individual expects to be able to handle a situation with a positive result (coping), the activation will be short and do no harm. Kivioja et al. found no evidence that early coping strategies influenced the prognosis after whiplash injuries. Others, however, found that high levels of passive coping strategies are associated with a slower recovery after whiplash injury, and that certain coping strategies for pain, such as catastrophizing, is associated with increased risk of disability, and that the importance of coping strategies seem to increase over time. In general, there is considerable controversy as to the importance of psychological factors for developing chronic whiplash associated disorders.

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July 19, 2010

Five years post whiplash injury: Symptoms and psychological factors in recovered versus non-recovered

Filed under: Neck Pain,Whiplash — Administrator @ 6:23 am

Five years post whiplash injury: Symptoms and psychological factors in recovered versus non-recovered

From: BMC Res Notes. 2010 Jul 13;3(1):190.

The incidence rate of whiplash injuries in Sweden is estimated to be 1.0-3.2/1000 /year. The injuries constitute a major health problem in Western society due to the large number of people with Whiplash associated disorder and the high economical costs associated with whiplash associated disorder. People with acute whiplash associated disorder, mainly complain of neck pain, stiffness, headache and dizziness. Other symptoms that may occur after the injury are fatigue, concentration and memory problems. Most subjects with acute whiplash associated disorder are reported to recover within three months of the trauma however, a significant number of persons experience symptoms several years after the accident. Persistent neck pain has been reported in 84-90% one to two year and in 55% 17 years after the injury.

It is still unclear why pain and related symptoms do not resolve after the expected time of healing and which factors are involved in the persistence of symptoms and impairments after the trauma. A bio-psycho-social model is often used to describe the complex interaction of physical and psychological factors in the development of chronic whiplash associated disorder. The long lasting problems after the injury may also interfere with occupational activities, the number of persons on sick-leave or unable to perform their ordinary duties six months after whiplash associated disorder have been reported to vary between 13 and 50%. In addition, chronic whiplash associated disorder may also affect leisure and daily life with social contacts and the total experience of life satisfaction.

Many studies of long-term problems after whiplash associated disorder have primarily focused on symptoms, especially neck pain in people seeking health care but fewer studies have investigated the long-term effects on activity/disability and life satisfaction. In addition, less is known about the differences between subjects who consider themselves as recovered and those who suffer from persistent disability. Sterling et al investigated post-traumatic stress in relation to disability on the Neck Disability Index during the first six months after whiplash injury. They found that persons who reported themselves to be recovered or to have mild disability six months post trauma reported decreased post-traumatic stress scores in comparison with early after the injury, whereas persons with moderate/severe disability reported persistent post-traumatic stress scores into the chronic stage.

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July 15, 2010

A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research

Filed under: Chiropractic,Whiplash — Administrator @ 3:02 pm

A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research

From: Work. 2010;35(3):369-94

The literature relevant to the treatment of Whiplash Associated Disorders is extensive and heterogeneous. A Participatory Action Research approach was used to engage a chiropractic community of practice and stakeholders in a systematic review to address a general question: ‘Does chiropractic management of whiplash associated disorders clients have an effect on improving health status?’ A systematic review of the empirical studies relevant to whiplash associated disorders interventions was conducted followed by a review of the evidence.

The initial search identified 1,155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of whiplash associated disorders intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with whiplash associated disorders is reported. Further review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: the whiplash associated disorders-plus model.

There is a baseline of evidence that suggests chiropractic care improves cervical range of motion and pain in the management of whiplash associated disorders. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The whiplash associated disorders-plus model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, subacute and chronic pain due to whiplash associated disorders. Furthermore, the whiplash associated disorders-plus model can be used in the future study of interventions and outcomes to advance evidence-based care in the management of whiplash associated disorders.

July 4, 2010

Differential development of sensory hypersensitivity and a measure of spinal cord hyperexcitability following whiplash injury

Filed under: Whiplash — Administrator @ 4:52 am

Differential development of sensory hypersensitivity and a measure of spinal cord hyperexcitability following whiplash injury

From: Pain. 2010 Jun 29. [Epub ahead of print]

Widespread sensory hypersensitivity is present in acute whiplash and is associated with poor recovery. Decreased nociceptive flexion reflex thresholds (spinal cord hyperexcitability) are a feature of chronic whiplash but have not been investigated in the acute to chronic injury stage. This study compared the temporal development of sensory hypersensitivity and nociceptive flexion reflex responses from soon after injury to either recovery or to transition to chronicity. It also aimed to identify predictors of persistent spinal cord hyperexcitability. Pressure and cold pain thresholds, nociceptive flexion reflex responses (threshold and pain VAS) were prospectively measured in 62 participants at <3 weeks, 3 and 6 months post whiplash injury and in 22 healthy controls on two occasions a month apart. Pain levels and psychological distress (GHQ-28; IES) were measured at baseline. Whiplash participants were classified at 6 months post-injury using the Neck Disability Index: recovered (8%), mild pain and disability (10-28%) or moderate/severe pain and disability (30%).

All whiplash groups demonstrated spinal cord hyperexcitability (lowered nociceptive flexion reflex thresholds) at 3 weeks post-injury. This hyperexcitability persisted in those with moderate/severe symptoms at 6 months but resolved in those who recovered or reported lesser symptoms at 6 months. In contrast generalized sensory hypersensitivity (pressure and cold) was only ever present in those with persistent moderate/severe symptoms and remained unchanged throughout the study period. This suggests different mechanisms underlie sensory hypersensitivity and nociceptive flexion reflex responses. In multivariate analyses only initial Neck Disability Index scores were a unique predictor of persistent spinal cord hyperexcitability indicating possible ongoing peripheral nociception following whiplash injury.

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July 2, 2010

Manual therapy and exercise for neck pain: a systematic review

Filed under: Neck Pain,Whiplash — Administrator @ 3:52 am

Manual therapy and exercise for neck pain: a systematic review.

From: Man Ther. 2010 Aug;15(4):334-54

Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk and standardized mean differences were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias. Low quality evidence suggests clinically important long-term improvements in pain, function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment. High quality evidence suggests greater short-term pain relief than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache. Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

June 23, 2010

Whiplash associated disorder predictors, treatment, social, economic and cultural aspects and definitions

Filed under: Whiplash — Administrator @ 2:36 pm

Whiplash

The following appear in Ugeskr Laeger. 2010 Jun 14 Articles in Danish

Predictors of chronic sequelae in whiplash trauma. 2010 Jun 14;172(24):1821-1824.

Prognostic factors for chronic whiplash associated disorder are identified. In whiplash associated disorder grade I-III, 50% report neck pain after one year (30% in background population). There is a female preponderance among WAD cases. 10% develop a work disability, but no gender differences are found. Age, crash issues, magnetic resonance imaging of the neck and smooth pursuit neck torsion test are of no prognostic value. While reduced active neck mobility is associated with a 4.6 times raised risk for work disability after one year, the impact-of-event score yielded an increase in OR of 3.3, and intense pre-injury distress was associated with a 2.1 OR for pain after one year and a 2.8 OR for work disability. Intense headache/neck pain and a multitude of non-painful complaints were both associated with a 3.5 to 4.0 times raised risk of work disability after a year.

Treatment of whiplash associated disorders. 2010 Jun 14;172(24):1818-1820.

Treatment of whiplash associated disorders starts with a thorough clinical examination, which may be repeated after 1-3 weeks. For optimal results it is essential that the patient receives clear information about the condition and that any pain is treated effectively with analgesics. Risk factors for persistent symptoms can often be identified early and should be addressed adequately. If symptoms persist and conservative treatments are chosen, these should be active and they should focus on sustaining or regaining usual activities.

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June 11, 2010

What Influences Positive Return to Work Expectation?: Examining Associated Factors in a Population-Based Cohort of Whiplash-Associated Disorders

Filed under: Neck Pain,Whiplash — Administrator @ 3:35 am

What Influences Positive Return to Work Expectation?: Examining Associated Factors in a Population-Based Cohort of Whiplash-Associated Disorders.

From: Spine (Phila Pa 1976). 2010 Jun 8. [Epub ahead of print]

This was a cross-sectional study of population based traffic cohort to determine which factors are associated with both positive and negative expectations for returning to work after vehicle collision resulting in neck pain. Positive expectations predict better outcomes for a variety of health conditions, including return to work from soft-tissue injury (including whiplash associated disorders. However, we know little about those with negative expectations who may be at risk for poor whiplash associated disorder outcomes.

The authors assessed expectations for return to work in a population-based cohort of 2335 individuals with traffic related whiplash associated disorder. They used logistic regression analysis to model factors associated with expecting to return to work (compared with not expecting to return to work or being unsure).

Depressive symptomatology, lower education, lower income, male sex, and greater initial pain (greater percentage of body in pain and greater intensity of neck pain) were associated with lower return to work expectation. A number of demographic, socioeconomic, and injury-related factors were associated with expectations for return to work in whiplash associated disorder. Two of the strongest associated factors were depressive symptomatology and postcollision initial neck pain intensity. These results support using a biopsychosocial approach to evaluate expectancies and their influence on important health outcomes.

This confirms an earlier study in J Rehabil Med. 2010 Jan;42(1):66-73. Factors associated with recovery expectations following vehicle collision: a population-based study. It was concluded, “A number of demographic, socioeconomic and injury-related factors were associated with expectations for recovery in whiplash associated disorders. Two of the strongest associated factors were depressive symptomatology and initial neck pain intensity. These results support using a biopsychosocial approach to evaluate expectancies and their influence on important health outcomes.” This study found depressive symptomatology, lower education, lower income, male gender, younger age, being a passenger in the vehicle, history of neck pain, and greater initial pain (greater percentage of body in pain, greater intensity of neck pain and presence of low back and/or headache pain) were associated with poor expectations for recovery.

June 10, 2010

Are coping and catastrophising independently related to disability and depression in patients with whiplash associated disorders?

Filed under: Neck Pain,Whiplash — Administrator @ 3:31 am

Are coping and catastrophising independently related to disability and depression in patients with whiplash associated disorders?

From: Disabil Rehabil. 2010 Jun 7. [Epub ahead of print]

The aim is to study how pain coping strategies and catastrophising are related to disability and depression in patients with whiplash associated disorders. Specifically, the authors wanted to test if they are independent predictive variables, after controlling for pain severity, sociodemographic and crash-related variables.

A convenience sample of 147 patients with whiplash associated disorders of less than 3 months of duration was recruited. They were requested to complete the Pain Catastrophising Scale, the two-item version of the Chronic Pain Coping Inventory and to report sociodemographic and crash-related information, pain intensity, disability and depression.

Although several pain coping strategies were related with disability in univariate analyses, only asking for assistance was a marginally significant predictive variable in a multiple regression analysis after controlling for catastrophising. Catastrophising was a significant predictive variable after controlling for pain coping strategies. With depression as the outcome, resting and task persistence were the only pain coping strategies which were related in univariate analyses. However, none of them were predictive variables after controlling for catastrophising. Again, catastrophising was a significant predictive variable after controlling for pain coping strategies.

The results show that catastrophising about pain is more important than pain coping strategies in patients with whiplash associated disorders of a short duration. These results can contribute to the conceptual distinction between pain coping strategies and catastrophising.

Source: The Pain Catastrophizing Scale Development and Validation

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