MRIs Can Predict Chronic Pain After Whiplash Injury

January 15, 2016May 10, 2016 / Thomas Cohn, MD

Whiplash occurs when a person’s head is thrust forward or backward in a violent motion, over stressing the muscles and soft tissues in the area. The most common cause of whiplash is a car accident, especially accidents involving a rear-end collision. In this scenario the person who gets rear-ended will be thrust forward, but their head will usually snap backwards as their body is propelled forward.

Depending on the severity of the whiplash, most patients recover from their injury within 1-2 months, but others aren’t so lucky. For some, neck pain due to a whiplash injury becomes chronic, and symptoms remain for months or even years.

Luckily, we’re getting better at assessing whiplash symptoms and predicting who may suffer from long-term symptoms. With help from special MRI imaging, doctors are able to pinpoint with a fair degree of certainty which patients will develop chronic pain, disability and PTSD in the wake of a whiplash injury.

Chronic Pain Prediction

According to researchers at Northwestern Medicine, doctors can predict which patients will develop long-lasting symptoms within the first 14 days from the date of injury. By pinpointing which patients are likely to suffer long-term symptoms, doctors can better treat patients and help prevent potential setbacks down the road.

“This opens up a new door for research on whiplash,” said lead researcher James Elliott said. “For a long time whiplash has been treated as a homogenous condition. Our study has shown these patients are not all the same; they have different clinical signs and symptoms.”

The special MRI technique measures the fat/water ratio in the muscles of a person’s neck, and scientists uncovered that patients who would go on to suffer long-lasting symptoms had larger ratios of fat in their neck muscles. They believe this fatty infiltration could lead to atrophy of the muscles, and their findings were consistent no matter the size or BMI or the patient.

Elliot believes the findings may be most significant for individuals who suffer from PTSD in the wake of a whiplash injury or a traumatic car crash. If a person is deemed at-risk for emotional instability after an accident, doctors can help them get the treatment they need earlier, which can lead to better outcomes.

“These patients have shown to not respond well to traditional rehabilitation such as physical therapy,” Elliott said. “It appears that they may require a more concerted effort for pain management from their physician and help from a psychologist.” Emerging, yet preliminary evidence suggests this to be a reasonable strategy.

The Benefits of MRI For Whiplash Injuries

April 2, 2015 / Thomas Cohn, MD

Whiplash injuries typically occur during a car accident, but they can happen during any event that causes your head and neck to move in in a violent manner. The majority of people who suffer a whiplash injury fully recover within a month or two, but for about 25 percent of the population, long-term pain and chronic pain persists.

Thankfully, we’re getting better at predicting which whiplash sufferers will have to deal with long-term effects through new MRI techniques. According to researchers, scientists can now predict which patients will develop chronic pain and partial disability within the first one to two weeks of the initial injury. They believe the earlier diagnosis will help doctors better develop a specialized treatment plan to treat the condition.

What The MRI Reveals

Researchers said the MRI reveals fat/water ratio in a person’s muscles, and unusual muscular changes one to two weeks post-injury can predict future chronic pain. The MRI uncovered that excess fat entering the patient’s neck is the key indicator.

“We believe this represents an injury that is more severe than what might be expected from a typical low-speed car crash,” says lead investigator James Elliott, assistant professor of physical therapy and human movement sciences at Northwestern University Feinberg school of Medicine. “This opens up a new door for research on whiplash. For a long time whiplash has been treated as a homogenous condition. Our study has shown these patients are not all the same; they have different clinical signs and symptoms.”

Elliott added that routine x-ray imaging does not reveal this fat infiltration, and the MRI appears to be an optimal route. Despite the findings, researchers haven’t pinpointed a preferred treatment option for whiplash sufferers who are at risk for future chronic pain.

“We haven’t found an effective treatment for these folks with chronic whiplash,” said Elliott.

Although they are still working on a solution, researchers said the findings are important because they help prove to whiplash sufferers that their chronic pain isn’t just in their head.

“If you’re a whiplash patient with ongoing chronic pain, but no objective imaging finds anything wrong, people are frequently informed that nothing is wrong with them,” Elliott says “It’s been a huge problem. That fat appears to be a response to an injury. What has actually been injured remains for us to find out. But now we know to look more deeply into the problem.”

Related source: Northwestern University

Neck Pain – Nerve Irritation, Whiplash, & Muscle Spasms

January 15, 2014June 24, 2014 / Thomas Cohn, MD

This is part two of our blog mini-series on Neck Pain. You can find the first installment here. Our first post focused on chronic neck pain causes and treatments at a general level. c

Nerve Irritation

Cervical discs in the neck that cause nerve irritation can have both axial pain or pain in the arms. MRI or CT scans are necessary to see these structures and determine the severity of the changes. If the changes have been slow degeneration, the body can often adapt to them even if there is severe narrowing where the nerves travel. Treatment often includes cervical epidural steroid injections to calm spine irritation and inflammation. Controlling nerve sensitivity can be helped by medications known as neuropathics that include some seizure drugs and antidepressants. Physical therapy and behavioral health interventions are also beneficial.

Whiplash

Whiplash and cervical facets cause pain from abnormal movement or sensitivity of the joints between each of the cervical vertebra. Patterns of pain from these joints are fairly specific, and are mostly along the spine from the base of the skull, out to the shoulders, and down through the shoulder blades. Treatment ranges from heat and ice, massage, manipulation, acupuncture, anti-inflammatory medications, traction and physical therapy, to injections. Most pain responds to simple things, about 5-10 percent need the more complex treatment such as steroid injections, nerve blocks, and radiofrequency lesioning to prevent pain feedback from the joints.

Muscle Spasms

Muscle spasms of the neck can be primary problems, or secondary to a deeper problem in the spine. If the spasms are chronic, it is more likely they are due to a deeper structure like the facets or discs, and treating those problems will significantly improve the spasms. At times, spasms continue despite treating all other problems and pain is chronic. For this type of problem, chronic use of muscle relaxers along with therapy is often necessary. Botox, which is a medication that is injected into the muscle to partly paralyze it for several months, is also helpful.

Neck pain that is chronic and ongoing is a difficult problem to treat due to its many causes. A Physical Medicine pain specialist can be especially helpful in the diagnosis and management of the problem. They often can determine all the factors that are contributing to ongoing issues and develop a comprehensive strategy to manage the symptoms. Treatment often is not simple, but working with an experienced specialist can help with a successful long-term solution to a frustrating problem.

4 Types of Pain after a Car Accident (and Treatment Options)

September 3, 2013June 24, 2014 / Thomas Cohn, MD

Car accidents nearly always result in injury. These injuries can be mild to severe, but most often cause some form of pain. Here are some of the most common forms of pain that occur after a car accident and pain management options for each:

Neck pain from whiplash. Whiplash is perhaps the most common injuries sustained as a result of a car accident. It can result from the most catastrophic wreck, or the smallest parking lot fender bender. It occurs during accidents when the vehicle impact jerks the head around so much so that the neck over or hyper extends. Whiplash can cause neck pain, stiffness, and headaches. Often, people with whiplash do not feel symptoms until well after the accident.
Back pain from a herniated or bulging disc. Similar to neck injuries and whiplash, the spinal cord can sustain injury due to the violent jerking motions associated with many car collisions. The bones in your spine are cushioned by discs. During a car crash, these discs can slip out of place and cause pain. Read more about herniated discs.
Head pain due to Concussion. It is common for people in car accidents to hit their head on the steering wheel, headrest, or vehicle interior. If the head is hit hard enough it can become concussed – resulting in headaches, confusion, and loss of consciousness.
Leg, ankle, foot pain. In more severe car collisions, when there is substantial structural damage to the vehicle, injuries to the lower extremities can occur. These can range from slight sprains, to broken bones. Pain from these injuries also ranges greatly depending on the extend of the damage.

Pain Management Options

Whiplash. Treatment options can include a judicial use of NSAIDs, physical therapy, and use of a neck brace.
Spine injuries. Back pain from spinal injuries can be managed with medications, physical therapy, and injections.
Concussion. If you think you may have a concussion it is important to seek medical help immediately. Concussion severity can range greatly. Slighter concussions should be treated with simple rest. More severe concussions can have a negative impact on your memory and reflexes. In the most extreme cases hospitalization may be required.
Leg pain. Again, treatment options largely depend on the injury sustained, but generally the RICE method is the first option for treatment. Physical therapy or surgery may be required with more severe injuries.

Car accidents are common occurrences that can result in a number of painful injuries. If you are still dealing with pain from a previous car accident, talk to your physician about a pain management plan that can help you back to a pain free life.