While there’s an abundance of published work on whiplash associated disorders (WAD), one of the most perplexing issues facing investigators is why nearly half of patients experience long-term, chronic issues. However, new research suggests that we may be closer to determining why this is the case and which patients may be at greatest risk so a more comprehensive treatment approach can be provided.
Examinations of patients with chronic whiplash associate disorders (cWAD) have revealed an increased likelihood of nerve injury and neuropathic pain—pain that is usually described as a burning sensation and can make the affected area sensitive to touch—when compared with WAD patients who recovered. These cWAD patients also demonstrate decreased sensory perception, exhibit signs of nerve inflammation on MRI, have skin biopsies that reveal structural degeneration of small fiber nerves, and experience a reduction in their overall quality of life and emotional wellbeing.
A July 2022 systematic review and meta-analysis looked at clinical data concerning over 400,000 WAD patients that indicated that 34% of patients may have had neuropathic pain, while only 13% had received a diagnosis indicating nerve pathology. This is important because the most common diagnosis for WAD is grade II, which includes symptoms of pain and physical signs of reduced cervical range of motion in the absence of neurological findings.
The review also found that patients with neuropathic pain also demonstrated significantly impaired sensory (mechanical, current, cold, and warm) detection thresholds of the index finger, independent of their WAD classification (WAD I—mild symptoms without physical signs; WAD II—symptoms and signs without nerve injury; WAD III—symptoms and signs with nerve injury; WAD IV—fracture/dislocation). The authors summarize that their findings appear to have identified a subset of WAD patients that demonstrate signs of peripheral nerve injury and neuropathic pain previously not considered. They suggest modification of the current WAD classification as well as performing a more detailed assessment of nerve integrity during the patient’s initial examination.
Doctors of chiropractic utilize a structured history and assessment that includes neurological examination approaches mentioned in this study (such as two-point discrimination of the fingers, pressure pain thresholds, and neurodynamic testing) as well as the use of questionnaires to obtain an accurate diagnosis and to track patient progress. The physical techniques utilized by doctors of chiropractic to restore motion—which minimize pain and promote recovery—offer an excellent front-line treatment choice for the whiplash patient.
