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.
Whiplash Examinations
Examinations of patients with chronic whiplash associate disorders (cWAD) have revealed an increased likelihood of nerve injury and neuropathic pain. Pain is usually described as a burning sensation and can make the affected area sensitive to touch. This compares 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 well-being.
WAD Review
A July 2022 systematic review and meta-analysis looked at clinical data concerning over 400,000 WAD patients. Patients 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. This 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 demonstrated significantly impaired sensory 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. Patients 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.
Chiropractors utilize a structured history and assessment. Assessment includes neurological examination approaches mentioned in this study such as two-point discrimination of the fingers, pressure pain thresholds, and neurodynamic testing. The use of questionnaires obtains an accurate diagnosis and tracks patient progress. The physical techniques utilized by chiropractors restore motion. This minimizes pain and promotes recovery offering an excellent front-line treatment choice for the whiplash patient.
