What is Whiplash Pain?
Whiplash pain explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
Whiplash-associated disorders are pains and injuries associated with abnormal flexing and extension of the structures of the neck. These include damage to the cervical vertebrae (bones of the neck) and damage of the major ligaments in the neck. This can result in an additional instability in the vertebrae. Approximately half of all whiplash patients also suffer injury of the joints between these bones (facet joints). Whiplash is linked to the development of chronic pain, and in some cases, the emergence of a migraine-type headache. A patient recovering from whiplash may experience a decrease of neck motion, due to chronic pain. Whiplash pain is also associated with inflammation in the neck. As such, treatment for whiplash often includes therapies to reduce this.
Causes of Whiplash Pain
Whiplash is commonly linked to road traffic accidents. It is the result of a very sudden jarring of the cervical vertebrae (hyperextension and flexion) in situations where the body is subject to rapid acceleration and subsequent deceleration. These unnaturally abrupt and excessive forces acting on the neck is what causes damage to the muscles, nerves, and ligaments surrounding the cervical spine, and also often damage to the joints between individual vertebrae. The vertebrae, and their normal conformation, may also sustain damage. These injuries lead to the reduced ability to move the neck, and pain when this is attempted.
Whiplash may occur when one car incurs a violent impact from the rear, i.e. from another vehicle. It is also associated with recreational activities, such as skiing and with contact sports. Violent assault is another possible cause of whiplash. Whiplash-related disorders are associated with a significant economic and healthcare burden.
Treatment for Whiplash Pain
Whiplash treatment may begin with therapy such as acupuncture or chiropractic manipulation. Chiropractic therapy may aid the recovery from the excessive flexing and over-extension of the neck, and help relieve pain caused by ligament and muscle damage. This may result in a degree of restoration of normal movement of the neck. Conventional painkillers such as non-steroidal inflammatory drugs (NSAIDs) may also help in recovery from whiplash.
Epidural nerve injections are another option for long-term relief from pain. Also known as nerve blocks, they inhibit the spinal nerves responsible for pain signaling. Nerve blocks deliver pain-blocking compounds (local anesthetics and/or anti-inflammatory steroids) into the appropriate space around the spinal nerve root. Similar injections can be given to the medial branch nerves that serve the facet joints. Occipital nerve blocks can treat both whiplash-related headache and joint pain. These injections provide significant pain relief, lasting from weeks to months after a session. Nerve-blocking injections have some risks, however. These are the possibility of the wrong area of the cervical spine being injected, which can cause discomfort, neurological complications, and possible paralysis. Steroids can cause immune system dysfunction, weight gain, and stomach ulcers. Anesthetics can cause nerve damage, headache, and numbness after injection.
If these procedures fail to relieve pain associated with whiplash, another minor surgical procedure can be considered. Radiofrequency ablation (RFA) involves the use of thin probes in conjunction with imaging technology, such as magnetic resonance imaging (MRI), to pinpoint the specifics areas of spinal nerves that control the perception of painful stimuli (pain fibers). The probe is inserted under local anesthetic, and applies electro-thermal impulses to these fibers, disrupting their ability to send pain signals. RFA significantly reduces pain associated with whiplash, for as long as several months after treatment. The risks associated with this procedure are bleeding, infections, and discomfort at the probe insertion site. Improper probe insertion may also cause inadvertent nerve damage, resulting in losses of motor control or sensation.
Whiplash is most often associated with abnormal and violent flexing and extension of the neck, often from a rear-end collision in a motor vehicle accident. The resultant disorders and injuries can cause chronic pain. Whiplash can cause damage to cervical vertebrae, nerves, muscles, and ligaments. Approximately 50% of patients also suffer cervical facet joint damage. Treatments for whiplash include conventional painkillers and acupuncture. Chiropractic manipulation can help in correcting the over-flexing and hyper-extension of the neck. Nerve-blocking injections of medial branch nerves and cervical spinal nerves can significantly reduce whiplash pain. If these do not relieve pain, radiofrequency ablation is another effective option for chronic whiplash-associated pain.
- Eichenberger U, Greher M, Kapral S, et al. Sonographic visualization and ultrasound-guided block of the third occipital nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain. Anesthesiology. 2006;104(2):303-308.
- Tominaga Y, Ndu AB, Coe MP, et al. Neck ligament strength is decreased following whiplash trauma. BMC musculoskeletal disorders. 2006;7:103.
- Becker WJ. Cervicogenic headache: evidence that the neck is a pain generator. Headache. 2010;50(4):699-705.
- Smith AD, Jull G, Schneider G, Frizzell B, Hooper RA, Sterling M. Cervical Radiofrequency Neurotomy Reduces Central Hyperexcitability and Improves Neck Movement in Individuals with Chronic Whiplash. Pain medicine (Malden, Mass.). Oct18 2013.
- Smith AD, Jull G, Schneider G, Frizzell B, Hooper RA, Sterling M. A comparison of physical and psychological features of responders and non-responders to cervical facet blocks in chronic whiplash. BMC musculoskeletal disorders. 2013;14(1):313.
- Teasell RW, McClure JA, Walton D, et al. A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 5 – surgical and injection-based interventions for chronic WAD. Pain research & management : the journal of the Canadian Pain Society = journal de la societe canadienne pour le traitement de la douleur. 2010;15(5):323-334.
- Liliang PC, Lu K, Hsieh CH, Kao CY, Wang KW, Chen HJ. Pulsed radiofrequency of cervical medial branches for treatment of whiplash-related cervical zygapophysial joint pain. Surgical neurology. 2008;70Suppl1:S1:50-55; discussion S51:55.