I work as an EMT on an ambulance service. My sister is a nurse in an emergency department. We both see patients involved in motor vehicle accidents who end up with a chronic neck problem from whiplash. She thinks it's because the patients are told to expect that when they are discharged from the hospital. I think it's the ones who are hysterical and over anxious from the start. Does anyone really know?
Many studies have been done to identify what it is about some people who have a whiplash injury from a car accident that causes them to develop chronic neck pain. Is it the severity of the injury or the way they view the experience? A recent study from the Netherlands may help answer the question. The researchers looked at the role of catastrophizing and causal beliefs as possible predictive factors in postwhiplash syndrome.
Pain catastrophizing refers to a negative focus on pain, whether that pain is real or anticipated. A person's pain is increased or amplified and prolonged because of the way they view every physical action as a possible source of pain. This type of thinking becomes a habit and leads to chronic pain and disability.
Causal illness beliefs describe the patient's ideas about what originally caused the problem in the first place. In the case of a whiplash injury, the patient may have been given the wrong impression about their prognosis.
Information provided at the emergency department or in the doctor's office may have led him or her to believe there was severe, irreparable damage done to the neck. This impression added to the social or cultural belief that whiplash injuries are permanent could lead to a negative spiral in thoughts and actions.
The patient starts requesting more medical help. He or she constantly scans the body for any new symptoms or to check the severity of the old symptoms. Expecting pain and looking for symptoms can lead to more severe and longer lasting complaints. Intense anxiety and fear of pain are linked with a poor outcome or prognosis.
Social research has also shown that pain catastrophizing actually leads to more dysfunctional causal beliefs. In time, a vicious cycle is set up that creates a pathway from acute to chronic neck pain. The first study to prove that believing whiplash causes neck problems is actually a negative prognostic factor in chronic whiplash or postwhiplash syndrome has been published.
This information suggests that patient education is a critical feature in the management of the acute injury. If this proves true, guidelines will eventually be published to help early responders (EMTs, nurses, emergency room physicians, primary care physicians) victims of educate motor vehicle accidents what to really expect and how to prevent further problems from developing.