Whiplash

Sleep Characteristics in Patients with Whiplash-Associated Disorders: A Descriptive Study

By Frank M. Painter|January 7, 2014|Chiropractic Care, Whiplash|

Sleep Characteristics in Patients with Whiplash-Associated Disorders: A Descriptive Study

SOURCE: Topics in Integrative Health Care 2012 (Dec 31); 3 (4)

Jay Greenstein, DC, CCSP, CGFI-L, CKTP, FMS; Barton Bishop, DPT, SCS, CKTI, TPI, CGFI-MP, CSCS; Jean Edward, RN, BSN; Allen Huffman, DC, CKTP, BS; Danielle Davis; Robert Topp, RN, PhD

Study Objectives: The purpose of this study was to explore sleep habits and characteristics of patients with whiplash-associated disorders (WAD) presenting at an outpatient, chiropractic clinic using the Medical Outcomes Study (MOS) Sleep Scale.

Methods: Fifty-one patients from an outpatient chiropractic and physical therapy clinic specializing in spinal rehabilitation participated in this cross-sectional, descriptive study. Data were collected using a descriptive survey, the Visual Analog Scale (VAS), the Neck Disability Index (NDI), and the self-administered 12-item MOS Sleep Scale. Data analysis included descriptive statistics to describe pain, disability, and sleep characteristics of the study sample, and computation of confidence intervals to determine differences in means of sleep characteristics between the non-WAD population (as determined by previous studies) and the study sample of WAD patients.

Results: Results indicate that when compared to normative values of the non-WAD population, the sample of WAD patients in this study presents with significantly greater measures of neck disability (NDI), neck pain (VAS), sleep disturbance, snoring, shortness of breath and headache, sleep somnolence and sleep problems index I and II. This sample also presents with significantly lower measures of optimal sleep when compared to the general population.

Conclusion: Consistent with previous research, findings from this study indicate that WAD patients have increased neck disability and pain, and poorer sleep outcomes, indicating the need for clinicians to assess sleep characteristics and incorporate interventions aimed at alleviating these symptoms when planning rehabilitation. Findings provide evidence for the need to further explore sleep disturbances among WAD patients to establish a stronger understanding of the course and prognosis of this condition.

From the FULL TEXT Article:

Introduction

Neck pain related to whiplash-associated disorders (WAD) constitutes a significant health issue that leads patients to seek medical care in chiropractic and other physical therapy, rehabilitative clinics. Studies have indicated that individuals experience multiple clinical manifestations of WADs that lead to chronicity including postural changes, disability, headache, fatigue, and sleep disturbances. [1-4] Although studies have shown that sleep disturbances occur as a result of chronic pain, few studies have explored the relationship between patients with WAD and sleep quality. [4-6]

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Central Hypersensitivity In Chronic Pain After Whiplash Injury

By Frank M. Painter|December 1, 2013|Chronic Pain, Whiplash|

Central Hypersensitivity In Chronic Pain After Whiplash Injury

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SOURCE: Clin J Pain. 2001 (Dec); 17 (4): 306–315

Curatolo M, Petersen-Felix S, Arendt-Nielsen L,
Giani C, Zbinden AM, Radanov BP.

Department of Anesthesiology,
University Hospital of Bern,
Inselspital, Switzerland

OBJECTIVE: The mechanisms underlying chronic pain after whiplash injury are usually unclear. Injuries may cause sensitization of spinal cord neurons in animals (central hypersensitivity), which results in increased responsiveness to peripheral stimuli. In humans, the responsiveness of the central nervous system to peripheral stimulation may be explored by applying sensory tests to healthy tissues. The hypotheses of this study were:

(1) chronic whiplash pain is associated with central hypersensitivity;

(2) central hypersensitivity is maintained by nociception arising from the painful or tender muscles in the neck.

DESIGN: Comparison of patients with healthy controls.

SETTING: Pain clinic and laboratory for pain research, university hospital.

PATIENTS: Fourteen patients with chronic neck pain after whiplash injury (car accident) and 14 healthy volunteers.

OUTCOME MEASURES: Pain thresholds to: single electrical stimulus (intramuscular), repeated electrical stimulation (intramuscular and transcutaneous), and heat (transcutaneous). Each threshold was measured at neck and lower limb, before and after local anesthesia of the painful and tender muscles of the neck.

RESULTS: The whiplash group had significantly lower pain thresholds for all tests. except heat, at both neck and lower limb. Local anesthesia of the painful and tender points affected neither intensity of neck pain nor pain thresholds.

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Comparison of Outcomes in Neck Pain Patients With and Without Dizziness

By Frank M. Painter|January 8, 2013|Chiropractic Care, Dizziness, Spinal Manipulation, Whiplash|

Comparison of Outcomes in Neck Pain Patients With and Without Dizziness

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Chiropractic & Manual Therapies 2013 (Jan 7); 21: 3

B Kim Humphreys and Cynthia Peterson

University of Zürich and Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland

Background The symptom ‘dizziness’ is common in patients with chronic whiplash related disorders. However, little is known about dizziness in neck pain patients who have not suffered whiplash. Therefore, the purposes of this study are to compare baseline factors and clinical outcomes of neck pain patients with and without dizziness undergoing chiropractic treatment and to compare outcomes based on gender.

Methods This prospective cohort study compares adult neck pain patients with dizziness (n = 177) to neck pain patients without dizziness (n = 228) who presented for chiropractic treatment, (no chiropractic or manual therapy in the previous 3 months). Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQN) at baseline. At 1, 3 and 6 months after start of treatment the NRS and BQN were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was also collected. Improvement at each follow-up data collection point was categorized using the PGIC as ‘improved’ or ‘not improved’. Differences between the two groups for NRS and BQN subscale and total scores were calculated using the unpaired Student’s t-test. Gender differences between the patients with dizziness were also calculated using the unpaired t-test.

Results Females accounted for 75% of patients with dizziness. The majority of patients with and without dizziness reported clinically relevant improvement at 1, 3 and 6 months with 80% of patients with dizziness and 78% of patients without dizziness being improved at 6 months. Patients with dizziness reported significantly higher baseline NRS and BQN scores, but at 6 months there were no significant differences between patients with and without dizziness for any of the outcome measures. Females with dizziness reported higher levels of depression compared to males at 1, 3 and 6 months (p = 0.007, 0.005, 0.022).

Conclusions Neck pain patients with dizziness reported significantly higher pain and disability scores at baseline compared to patients without dizziness. A high proportion of patients in both groups reported clinically relevant improvement on the PGIC scale. At 6 months after start of chiropractic treatment there were no differences in any outcome measures between the two groups.

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Introduction

The complaint of neck pain is second only to low back pain in terms of common musculoskeletal problems in society today with a lifetime prevalence of 26-71% and a yearly prevalence of 30-50%. [1, 2] Most concerning is that many patients, particularly those in the working population or who have suffered whiplash trauma, will become chronic and continue to report pain and disability for greater than 6-months. [3-6] In terms of symptoms, dizziness and unsteadiness are the most frequent complaints following pain for chronic whiplash sufferers with up to 70% of patients reporting these problems. [7, 8] Apart from whiplash trauma, little is known about dizziness in the chronic neck pain population and much remains unknown about the etiology of chronic neck pain in general. [9]

Gender differences in reporting pain intensity is currently a topic of debate. Recent research suggests that females report more pain because they feel pain more intensely than males over a variety of musculoskeletal complaints. [10, 11] Furthermore, LeResche suggests that these differences may not be taken into account by health care providers, leading to less than optimal pain management for females. [12] However gender differences in neck pain patients with or without dizziness have not been described with respect to clinical outcomes over time.

Therefore, the purposes of this study on neck pain patients receiving chiropractic care are twofold:

to compare baseline variables and the clinical outcomes of neck pain patients with and without dizziness in terms of clinically relevant ‘improvement’, pain, disability, and psychosocial variables over a 6-month period;

to evaluate gender differences for neck pain patients with dizziness in terms of clinically relevant ‘improvement’, pain, disability, and psychosocial variables in a longitudinal study.

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A Systematic Review of Chiropractic Management of Adults with Whiplash Associated Disorders: Recommendations for Advancing Evidence-based Practice and Research

By Frank M. Painter|September 12, 2011|Guidelines, Whiplash|

A Systematic Review of Chiropractic Management of Adults with Whiplash Associated Disorders: Recommendations for Advancing Evidence-based Practice and Research

The Chiro.Org Blog

SOURCE: Journal of the Academy of Chiropractic Orthopedists 2011 (Mar); 8 (1)

By: Lynn Shaw, Martin Descarreaux, Roland Bryans, Mireille Duranleau, Henri Marcoux, Brock Potter, Rick Ruegg, Robert Watkin, Eleanor White

The literature relevant to the treatment of Whiplash Associated Disorders (WAD) is extensive and heterogeneous.

Methods: A Participatory Action Research (PAR) 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 WAD clients have an effect on improving health status?’ A systematic review of the empirical studies relevant to WAD interventions was conducted followed by a review of the evidence.

Results: The initial search identified 1155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of WAD intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with WAD is reported. For the review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: The WAD-Plus Model.

Conclusions: There is a baseline of evidence that suggests chiropractic care improves the cervical range of motion (cROM) and pain in the management of WAD. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The WAD-Plus Model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, sub-acute and chronic pain due to WAD. Furthermore, the WAD-Plus Model can be used in the future study of interventions and outcomes to advanced evidenced-based care in the management of WAD.

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Background

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Symptomatic Classification of Whiplash Injury and the Implications for Treatment

By Frank M. Painter|August 1, 2011|Whiplash|

Symptomatic Classification of Whiplash Injury and the Implications for Treatment

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SOURCE: J Orthopaedic Medicine 1999; 21 (1): 22–25

Khan S, Cook J, Gargan M, Bannister G

University Department of Orthopaedic Surgery,
Bristol, UK

Gargan and Bannister are renowned orthopedic trauma researchers from the Department of Orthopedic Surgery, John Radcliffe Hospital in Bristol, Oxford, England. In 1994, they published a paper in the European Spine Journal on the recovery rate of patients with whiplash injuries, and discovered that IF a patient was still symptomatic after three months, there was almost a 90% chance they would remain so. [1]

In 1995 they co-published a study with Woodward [2] that found that 93% of the chronic whiplash patients they studied experienced significant improvements with chiropractic care.

Chiropractic care in this study consisted of spinal manipulation, PNF and cryotherapy. Most of these 28 patients had already had prior medical treatment with NSAIDs, soft collars and physiotherapy.

Their third study reviewed conventional medical treatment for whiplash care, finding that it “was disappointing.”

The authors also found that:

“Chiropractic is the only proven effective treatment in chronic cases.”

The objective of their new study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment. [3]

They separated patients into one of 3 groups:

Group 1: patients with “neck pain radiating in a ‘coat hanger’ distribution, associated with restricted range of neck movement but with no neurological deficit.”

Group 2: patients with “neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement.”

Group 3: patients who described “severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes.” These patients also “described an unusual complex of symptoms,” including “blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain.” (more…)

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Chiropractic Care for Spinal Whiplash Injuries

By Frank M. Painter|July 29, 2011|Whiplash|

Chiropractic Care for Spinal Whiplash Injuries

The Chiro.Org Blog

SOURCE: J Orthopaedic Medicine 1999; 21 (1): 22–25

By David BenEliyahu, D.C.

Studies on the efficacy of chiropractic care for patients suffering with pain secondary to whiplash injury are appearing in the literature. In 1996, Woodward et al. published a study in Injury on the efficacy of chiropractic treatment of whiplash injuries. [1] The authors of this study were from the Department of Orthopedic Surgery in Bristol, England.

In 1994, Gargan and Bannister published a paper on the recovery rate of patients with whiplash injuries and found that if patients were still symptomatic after three months, there was almost a 90% chance they would remain so. [2] No conventional medical treatment has been shown to be effective in these established chronic whiplash injury patients. [3, 4] However, most DCs treating whiplash injury patients have empirically found high success rates in the recovery of these types of patients.

In the Woodward study, 93% of the 28 patients studied retrospectively were found to have a statistically significant improvement following chiropractic care. [1] Chiropractic care in this study consisted of spinal manipulation, PNF and cryotherapy. Most of the 28 patients had prior treatment with NSAIDs, soft collars and physiotherapy. The average length of time before the patients began chiropractic care was 15.5 months post-MVA (range of 3-44 months).

This study clearly documented what most DCs experience in clinical practice: that chiropractic care is an effective modality for patients injured in a motor vehicle accident. Symptoms ranging from headaches to neck pain, back pain, interscapular pain and related extremity pain with paresthesias all respond to quality chiropractic care.

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