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Development in pain and neurologic complaints after whiplash

A 1-year prospective study

From the Departments of Neurology (Drs. Kasch, Bach, and Jensen) and Rheumatology (Dr. Stengaard-Pedersen), Aarhus University Hospital; and Danish Pain Research Center (Drs. Kasch, Bach, Stengaard-Pedersen, and Jensen), Aarhus University, Denmark.

Address correspondence and reprint requests to Dr. Helge Kasch, Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Noerrebrogade 44, Building 1 C, DK-8000 Aarhus C, Denmark; e-mail: helge.kasch{at}dadlnet.dk

Objective: To prospectively examine the course of pain and other neurologic complaints in patients with acute whiplash injury and in controls with acute ankle injury.

Methods: Patients with acute whiplash (n = 141) and ankle-injured controls (n = 40) were consecutively sampled, and underwent interview and examination after 1 week and 1, 3, 6, and 12 months. Outcome measures were pain intensity, pain frequency, and associated symptoms.

Results: Initial overall pain intensity above lower extremities (pain in neck, head, shoulder-arm, and low back) was similar in patients with whiplash (median Visual Analogue Scale [VAS]_0–100 of 20 [25th and 75th percentile, 4, 39]) and ankle-injured controls (median VAS_0–100 of 15 [5, 34]). Whiplash-injured patients reported median overall VAS_0–100 pain intensity above lower extremities of 23 (12, 40) after 11 days and 14 (12, 40) after 1 year. Controls reported pain intensity of 0 (0, 4) after 12 days and 0 (0, 9) after 1 year. Reported overall pain frequency above lower extremities was 96% after 11 days and 74% after 1 year in whiplash-injured patients and 33% after 12 days and 47% after 1 year in controls. Associated neurologic symptoms were two to three times more common after whiplash injury. Correlation was found between pain intensity and associated symptoms in whiplash-injured patients but not controls.

Conclusion: Pain occurs with high frequency but low intensity after whiplash and ankle injury. Associated neurologic symptoms were not correlated to pain in ankle-injured controls, but were correlated to pain in patients with whiplash injury. Persistent symptoms in whiplash-injured patients may be caused by both specific neck injury–related factors and nonspecific post-traumatic reactions. Disability was only encountered in the whiplash group.

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