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Medical Litigation News |
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WHIPLASH INJURY OF THE CERVICAL SPINE 1993
Jaw (temporomandibular) joint pain, restricted jaw opening and tenderness of the muscles of chewing were sufficiently common in an unselected group of patients with neck whiplash that the authors[1] recommend routine assessment of the TMJ, whether or not the client complains spontaneously.
One in seven whiplash patients still had significant pain after more than 3 (average 8) years[2]. Early indicators were front seat position, onset of pain within 12 hours of injury, past history of neck pain, and degenerative changes on xray. Early onset of pain also predicted more severe persistent pain. Timing of compensation did not influence the improvement of symptoms. Whiplash did not accelerate the development of degenerative changes.
Sufferers from chronic internal pain also have a greater sensitivity to outside pain. Whiplash patients, demonstrably more depressed and anxious than other general medical practice attenders, reported more pain in response to a standardized test of cold pressure[3].
The 7% of patients who were partially or completely disabled at 6 months after whiplash had the following profile at the time of injury: greater age, greater initial intensity of neck pain, initial back pain, blurred vision, and anxiety; they had less dizziness, less sensitivity to noise, and fewer neurotic or behavioural problems in childhood. There were no differences in psychosocial stress, anxiety/depression or personality traits[4].
Out of 21 whiplash patients, all of whom had returned to work by 1 year, one in 5 still had cognitive problems[5], suggesting damage to basal frontal and upper brainstem structures.
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