Recovering from Whiplash – What Are Your Options?

Chronic spinal degeneration, stress and muscle strain are not the only causes of neck pain: An acute injury, like a fall or a car accident, can cause whiplash and neck pain that takes weeks, months, or even years to recover from and which may, in some cases, cause permanent cervical spinal problems. Early treatment for whiplash can help prevent chronic problems but the difficulty is that symptoms sometimes do not arise in the immediate aftermath of an accident. Knowing if spine surgery is necessary for whiplash and neck pain or whether a less invasive treatment could be of benefit is difficult but recent reviews are gradually giving us a clearer picture of how best to improve outcome after such an injury.

Treatment Options for Whiplash

Neck surgery, steroid injections, radiofrequency neurotomy and even botox treatment for whiplash have all been proposed as possible whiplash treatments. Of these, only radiofrequency neurotomy was concluded to have moderate evidence supporting its use by a review back in 2010. Other ways to relieve acute whiplash symptoms and reduce the likelihood of chronic whiplash associated disorder, chronic neck pain and other issues include:

• Natural anti-inflammatories
• mindfulness practice
• physical therapy
• cognitive behavioral therapy
• non-steroidal anti-inflammatories.

Steroid Injections for Whiplash-Associated Neck Pain

Unfortunately, steroid injections can cause further degradation of the spine’s soft tissues but may help relieve inflammation and neck pain in the short term and allow the body to begin healing from the injury. Evidence of the benefits of methylprednisolone injections for whiplash is mixed, with some trials showing that such treatment helps reduce the severity of disabling symptoms and helps people get back to work faster and other research showing that such injections offer no advantage over general analgesics.

Botox Injections for Neck Pain After Whiplash

Botulinum toxin-A (Botox) can help reduce neck stiffness and numb neck pain after whiplash but this may inadvertently worsen the long-term prognosis of a patient. Neck stiffness may actually be helpful immediately after whiplash injury as it can protect the spine from further trauma due to sudden movement. By relaxing the muscles in the neck, botox injections for whiplash, as well as other neck conditions, can promote degeneration of spinal tissues through friction, pressure and shocks to the area; this may inadvertently worsen the long-term outcome for patients with whiplash by destabilizing the spine. Botox injections for whiplash were not found to give any significant benefit over placebo treatment in the review of nonsurgical interventions for the condition.

Neck Surgery for Whiplash

Neck surgeries carried out for whiplash associated disorder may include a discectomy where discs in the cervical spine have been damaged by the neck trauma, along with cervical spinal fusion if the stretching of the joint capsule has created instability in the neck. Both types of surgery are considered last resorts in most cases after a failure to improve a patient’s condition using non-invasive techniques.

Patients with neck and shoulder pain who underwent surgery for carpal tunnel decompression had their pain relieved in some 95% of cases, compared to just 7% of those not having surgery experiencing such resolution of symptoms. However, these results were from a single study and so surgeons and physicians are still left with difficult decisions about how best to treat whiplash. Further, randomized and placebo-controlled trials are necessary to elucidate best practice for neck pain and whiplash associated disorder with investigation of pulsed magnetic field treatment radiofrequency neurotomy and intra-articular injections all prime candidates for future larger studies.

In addition to focusing on your options for treating whiplash, it can also be helpful to think about how best to prevent whiplash from occurring again in the future.

Reference

Teasell, R.W., McClure, J.A., Walton, D., Pretty, J., Salter, K., Meyer, M., Sequeira, K., Death, B., A research synthesis of therapeutic interventions for whiplash-associated disorder: Part 1 – overview and summary, Pain Res Manag. 2010 Sep-Oct; 15(5): 287–294.