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Chiropractic Research Review

Whiplash: Considering Psychological Factors

Many physical factors may be involved in whiplash pain, including musculature; the spinal column and its alignment; head rotation; automobile seat contour; and type of restraint used in the accident (e.g., seat belt).

It is estimated that up to 40% of motor-vehicle-accident patients suffer from psychological distress in addition to having physical injuries, and may exhibit pain and stiffness that exceeds their physiological examination findings.

The reasons for chronic whiplash pain vary from physiological to psychological, with many possible combinations of these factors. This review focused on two of the psychological variables affecting whiplash: acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Key points of the review related to psychological symptoms of whiplash are:

* ASD follows an injury involving intense fear, and later symptoms are dissociation marked by numbing and reduced awareness; recurring thoughts about the event; stress and anxiety; and impaired social/occupational function for less than one month.
* PTSD is similar to ASD, but symptoms last longer than one month. Late-onset PTSD is similar but initially occurs much later (more than one year after injury). Children with PTSD typically exhibit stomachaches, nightmares, and violent play behaviors.

Conclusion: Sources considered for the cause of whiplash pain are too-often limited to physiological sources, and do not include psychological distress. Psychological conditions should be considered if a patient does not steadily recover from whiplash symptoms. The author recommends that a patient should undergo concurrent psychological treatment when these factors are involved. Early detection of both physiological and psychological factors can facilitate prompt and effective treatment to minimize effects of ill health. The author concludes, "By failing to recognize, document, and seek appropriate treatment for these patients, we needlessly condemn them to a lifetime of suffering and pain."

Lamb KL. Psychological aspects of whiplash injuries: Recognition and treatment recommendations. Topics in Clinical Chiropractic 2001:8(3), pp. 20-35.
Reprints: (800) 638-8437

Chiropractic Research Review

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