Author: E. Paul Giersch

In the February 2001 issue of The Advocate, we reported on a study from Sweden, published in the Journal of Clinical Epidemiology, which revealed that whiplash victims experienced a three-fold increased risk of neck and shoulder pain at seven years post injury.*

In a follow-up article published in the same journal, the authors of the original study have revealed the results of their inquiry into the association between whiplash injury and other health complaints (notably headache, thoracic pain and low back pain) at the same seven year benchmark.**

This was a cohort study involving persons between 18 and 65 years of age. Drivers exposed to a rear-end auto collision in 1987 and 1988 were divided into roughly equal subgroups: those who had reported whiplash injury (232) and those who had reported no injury (204). Another group of 3,688, unexposed to motor vehicle collision, was used for comparison. In 1994, questionnaires were sent to all study subjects, omitting any reference to their rear-end collision experience, and inquiring about the prevalence of particular health complaints (eight outcome categories).

The results were sobering. No increased risk was found among the non-injured, whiplash-exposed subjects in any of the eight outcome categories (compared to the unexposed group). Among the injured whiplash subjects, however, there was a significantly increased risk for headache, thoracic pain, low back pain, fatigue and sleep disturbance. The authors note that these are the most common whiplash complaints, along with neck pain. The increased relative risks for these outcomes among the injured subjects ranged from 1.6 to 3.7.

The authors also note that among the injured subject group, almost all had been classified as having "minor" injuries from the rear-end collision event. 68% had reported neck injury only, while 32% also reported other injuries, most commonly to the lumbar spine.

Several related issues are discussed by the researchers. Among them is the suggestion that chronic symptoms may be related to psychological or social factors. The authors note that the literature seems to indicate that such profile factors are the result of chronic pain, and point to a study which failed to show any systematic high or low rating behavior of the type that would suggest bias among subjects who reported both exposure and outcome. They also note a study which reported that pre-surgery psychological distress among neurosurgical patients suffering with whiplash-associated neck pain resolved in all patients who became pain-free.

The authors conclude that "... rear-end collisions resulting in reported whiplash injuries seem to have a substantial impact on health complaints even a long time after the collision. There is a need to identify factors that predict a non-favorable outcome in order to improve clinical management".

CONCLUSION

This study, together with the researchers' earlier findings regarding the increased risk of neck and shoulder pain among whiplash patients, provides powerful confirmation of the clinical experience of those doctors and therapists who have struggled to understand and address the "late", chronic symptoms presented by auto accident victims. It will hopefully be read widely among those in the medical-legal community for whom such issues are especially relevant. Moreover, it should offer added validation, from the medical research community, for those auto accident victims who contend with chronic trauma residuals.

Very truly yours,
ADLER GIERSCH, P.S.

E. Paul Giersch
Attorney at Law

* Berglund, A, Alfredsson, L, et al. The association between exposure to a rear-end collision and future neck and shoulder pain: A cohort study. J Clin Epidemiol 2000; 53(11): 1089-94.

** Berglund, A, Alfredsson, L, et al. The association between exposure to a rear-end collision and future health complaints. J Clin Epidemiol 2001; 54: 851-6.