Monthly Archives: September 2012

Predictors of non-recovery among whiplash patients filing insurance claims

People with whiplash frequently experience long-term disability and pain. Many of these people have experienced whiplash as the result of an auto collision or other traumatic event, and seek compensation for their treatment. As an attorney, it is often critical to gauge the potential success of a claim and the potential for the patient’s long-term recovery, although there is little data to help lawyers do so.

A recent study sought to inform the claim screening process by identifying potential predictors of non-recovery or poorer prognosis. The study involved 246 patients who had claimed compensation for whiplash injuries between 2007 and 2009. Multiple analysis methods were used to identify potential predictors of poorer recovery among these whiplash patients.

Within three months of the initial injury, 23% of the participants had recovered from their injuries, while 9% had finalized their insurance claim. The significant predictors of poorer recovery were helplessness, older age, and pre-injury work status.

The researchers concluded that making additional information available at claim notification could improve the claim screening process by helping identify those with a risk of poor recovery.

Casey PP, et al. Identifying predictors of early non-recovery in a compensation setting: The Whiplash Outcome Study. Injury 2011; 42 (1): 25-32.

 

Whiplash patients have poorer posture control

As many as 70 percent of patients with whiplash report dizziness and unsteadiness. A recent study sought to characterize the postural control deficit, a primary cause of dizziness in patients with whiplash.

The researchers analyzed static postural recordings from 11 patients with whiplash and 11 healthy participants. The recordings were made with the participants’ eyes open, eyes closed, and eyes open and speaking. The measurements were analyzed to assess the amplitude and structure of postural variability, finding that the variability was larger among patients with whiplash when compared with the control group, indicating that postural control is diminished in those with whiplash.

Their are four potential causes of dizziness following an auto collisions. First are injuries to the cervical spine, located in the neck. It is connected to the postural control system, which takes information from the inner ear, eyes, and neck to help the body maintain balance. During an auto collision causing whiplash, proprioceptors in the neck can be disrupted, resulting in dizziness.

Secondly, dizziness can be a sign of benign paroxysmal positional vertigo. BPPV is caused when otoliths inside the inner ear are moved from their normal position by violent head movement. By confusing the postural control system, BPPV can cause dizziness that worsens when patients move their head and neck in certain directions. Other causes of dizziness include traumatic brain injuries and damage to blood vessels in the neck.

If you’re experiencing dizziness and balance problems after an auto collision, it’s crucial to see your health-care provider since it may be a sign of a brain injury, whiplash, or other disorder.

Reference

Madeleine F, et al. Characterization of postural control deficit in whiplash patients by means of linear and nonlinear analyses – A pilot study. Journal of  Electromyography and Kinesiology 2011; 21(2):291-7.

 

Is patient education effective for whiplash treatment?

Previous studies have pointed to the benefits of patient education in preventing chronic whiplash. But which education interventions are more effective? A recent literature review analyzed the existing research on whiplash education to determine its efficacy. Programs that integrated patient education with behavioral changes and exercise were successful in reducing pain and disability in patients with WAD. While simple oral advice suffices for patients with acute whiplash, those with chronic or subacute whiplash may require broader, multidisciplinary programs.

Given the variability of the education interventions, the researchers hesitated to draw firm conclusions about which program is more effective than the next. Their research does suggest however that patient education could be a vital component of whiplash recovery.

Chronic whiplash as a somatic syndrome

Chronic whiplash leads to a wide variety of symptoms, many of which are medically unexplained. Sufferers of chronic whiplash frequently report somatic symptoms from areas of their body not affected by neck trauma, such as sleep disturbances, shortness of breath, and gastrointestinal symptoms.

There are two competing hypotheses to explain why chronic whiplash symptoms such as these develop. The first considers both chronic whiplash and the relating symptoms to be the result of a specific, organic injury. The second considers chronic whiplash to be a functional somatic syndrome, in which the symptoms result from society-induced expectations, along with amplification of the initial symptoms.

A team of researchers recently sought to examine the prevalence of physical symptoms beyond those directly related to whiplash injuries. They used data from the Norwegian “Hordaland Health Study,” a population-based study involving nearly 14,000 participants, of whom 403 reported chronic whiplash. The tendency for somatization was measured using a list of 17 somatic symptoms covering a range of different organ systems and body parts.

Chronic whiplash was associated with increases of all 17 somatic symptoms included in the study. The authors argue that this increase in symptoms challenges the standard organic injury model, suggesting that chronic whiplash may be a functional somatic syndrome.

While several studies have examined symptoms of headache, dizziness and joint/muscle pain in whiplash patients, there has been little research on other somatic symptoms. The authors outlined various theories that attempt to explain the increase in symptom reporting among chronic whiplash patients: stress system responses can produce hormone changes that trigger hyperalgesia and allodynia; central sensitization can lead to the perception of pain in other parts of the body; and fear-avoidance, expectations, and anxiety/depression can contribute to chronicity.

“The debate over whiplash being a functional or organic disorder is by far settled by this study,” the authors wrote. Still, they concluded that patients in their study resemble “the diffuse and non-specific profile presented by individuals suffering from functional somatic syndromes.” They suggested that doctors continue encouraging their patients to stay active, use posture correction, and undercut any alarming expectations patients may have about the clinical course of their injuries.

Reference

Solbjørg, MM et al. Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK). BMC Psychiatry 2012; 12 (129): doi:10.1186/1471-244X-12-129.

TMJ symptoms more common in women

TMD symptoms may be more prevalent in women, suggests the results of a new study from the International Journal of Medical Science. The authors evaluated 243 patients with temporomanidular joint disorders (TMD) for general health, social status, pain, and other TMD symptoms. In both genders, the most common symptom was pain the temporal muscle, followed by pain with opening the mouth.

But women were much more likely than men to experience pain in the masseter muscle as well as clicking and grinding. Women also had a higher use of anti-depressant drugs than male patients. The findings suggests that the symptoms and signs of TMD are more frequent in female patients.

Nervous system changes trigger coordination problems in whiplash patients

Whiplash patients had impaired visual coordination compared to healthy participants in a recent study. While earlier studies showed that whiplash can impair the sensory and motor systems, this study suggests that distorted visual feedback may be a result of altered nervous system processing in whiplash patients. Changes to the nervous system can also occur as a result of central sensitization.

 

 

New crash test uncovers dangers of luxury sedans

According to a New York Times article, the Insurance Institute for Highway Safety has begun testing new cars with the “small overlap test.”

“The so-called small overlap test is meant to simulate the results of a crash in which the front corner of a vehicle collides with another vehicle or a stationary object like a tree or utility pole.”

According to the latest tests, 9 of 11 vehicles failed this test.

Here’s the full IIHS report.

 

Children with traumatic brain injuries can have persistent disabilities

Children who suffer from moderate to severe traumatic brain injuries may have functional disabilities and a poorer quality of life for at least two years after the initial injury, according to a new study published in the Journal of Neurotrauma.

Earlier research has found that children with brain injuries tend to have a reduced quality of life and poorer cognitive capabilities. Previously, children’s high neuroplasticity was believed to help them “bounce back” quickly from concussions but now research suggests that children can have more lasting cognitive deficits from the injuries.

Soldiers can suffer same brain disease as athletes, NSF explains

In May, Per Se Media blog covered a recent study that found that military veterans can suffer the same brain disease found in athletes with repeated concussions. Autopsies of four veterans showed that their brains had similarities to the brains of former athletes with the neurodegenerative disease called chronic traumatic encephalopathy (CTE). Now, a recent article from the National Science Foundation explains the implications of these findings with an easy-to-understand description of how CTE affects the brain.

Acupuncture reduces pain sensitivity in whiplash patients

Acupuncture could reduce central sensitization in patients with chronic whiplash according a new study from the European Journal of Pain. Previous research has shown that whiplash injury can induce central sensitization which can increase patients’ pain sensitivity and lead to chronic symptoms.

Researchers from Belgium sought to asses whether acupuncture treatment could disrupt the process of sensitization. In the study, 39 patients with whiplash-associated disorder (WAD) were randomly assigned to receive either relaxation therapy or acupuncture. Immediately following the treatment, acupuncture patients had more significant reductions in pressure pain sensitivity, a major indicator of sensitization. This led researchers to suggest that “acupuncture treatment activates endogenous analgesia in patients with chronic WAD.”

Interestingly though, there were no major differences between the groups when it came to reducing symptom severity and neck disability. Another more longer term study did show however that acupuncture improved functionality and pain symptoms in WAD patients. While more research is needed to understand the immediate and long-term effects of the treatment, these initial studies strongly suggest that acupuncture can effectively ease many whiplash symptoms.

The Belgian study was published just a day after a major literature review confirmed that acupuncture is an effective treatment for many types of chronic pain.

Reference

Tobbackx Y, Meeus M, Wauters L, et al. Does acupuncture activate endogenous analgesia in chronic whiplash-associated disorders? A randomized crossover trial. European Journal of Pain 2012; doi: 10.1002/j.1532-2149.2012.00215.x. [Epub ahead of print].