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Posted on 11-27-2016

Predicting Chronic Pain In Whiplash Injuries

As many of my avid blog followers are already aware, I am a Baltimore Chiropractor and I spend the majority of my clinic time treating whiplash injuries resulting from Baltimore auto accidents. As I've mentioned previously these injuries typically present with acute post-traumatic headaches, neck pain and back pain. Of course, no two patients are the same, and these are not hard and fast rules.

I find this work very rewarding because there is usually a predictable outcome for the majority of our acutely injured Baltimore whiplash patients. That is, they present with intense symptoms quickly after whiplash injury, they respond favorably over the first 3-4 weeks of care, and they continue to improve as we ween them off care and progress them onto home care. For the majority of our Baltimore whiplash patients, there is a complete resolution of their symptoms and complete return to normal activities of daily living.

Unfortunately, not all Baltimore whiplash patients respond well to treatment. And this seems to be true regardless of age, gender, vehicular damage or prior injuries. I have been treating these types of patients for about eight years and I've often wondered why, despite my best effort, some patients make a complete recovery while others do not. And while I still don't think we have a "perfect answer", I think I have a bit more understanding of why that may be.

Research from the journal SPINE attempted to look at chronicity of pain in whiplash patients and they found that there was a link between early muscle fatty infiltrates (MFI) in the neck multifidi muscles and the chronicity of pain in whiplash patients. You can see a link to the abstract from the article here.

They studied 36 whiplash subjects that were enrolled in the study less than a week after sustaining whiplash injuries. They studied these subjects at 1 week, 2 week, and three months post injury, measuring self-reported pain-related disability questionnaires, self-reported post-traumatic stress disorder questionnaires, and fat/water MRIs of their necks. They found that those subjects with higher levels of reported pain throughout the study had higher levels of MFIs in the cervical (neck) multifidus muscles.

The authors of the study suggest that we can use specialized MRIs to make predictive outcomes early on in care to determine who, despite rehab, chiropractic care, and physical therapy, are likely to have chronic pain following whiplash injuries. We can look at the MFIs in their neck muscles and based on that make predictions about who will be left suffering with chronic neck pain.

I find this result particularly fascinating for its implication in my practice. Often if patients are not having favorable outcomes to treatment and continue to report high levels of neck pain, we refer them for MRIs. The MRIs will typically focus on ligaments, intervertebral discs, and neurological tissues (nerve roots and the patency of neural foramina) while looking for evidence of pathophysiology. When these MRIs come back "negative" for disc injuries and nerve root compression, certain whiplash patients are considered to be "malingerers", "liars", or "crazy." But maybe they aren't. Maybe we need to run a different type of MRI and look for evidence of MFI as a cause of their reported chronic pain. Its something I will spend more time thinking about and discussing with radiologists who I refer MRI work to.

In the meantime, if you, or someone you know, has neck pain due to a Baltimore whiplash injury, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

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