WHIPLASH AND THE ELDERLY NECK
This month’s issue of Annals of Emergency Medicine (Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study) shows us why this is a big deal — mostly because these sorts of injuries are so common. “Motor vehicle crashes are the second most common form of traumatic injury among individuals aged 65 years and older and result in an estimated 250,000 US emergency department (ED) visits by older adults each year.” The study then reveals an important truth about these “older adults“. “Because safe and effective pharmacologic management of their acute pain is challenging, and once pain becomes persistent in older adults, it has profound negative consequences for function and quality of life.”
The problem is, drugs don’t work for these sorts of mechanical injuries. Never have, never will. You can’t fix a mechanical problem in your car by adding chemicals or simply changing the oil; and you certainly can’t do it in your body. While things like PAIN PILLS, MUSCLE RELAXERS, ANTI-INFLAMMATORY MEDS, and CORTICOSTEROID INJECTIONS have the potential to cover symptoms on a temporary basis, they are never a long-term solution. Nor are the ANTIDEPRESSANTS that will be prescribed on their heels when they don’t work.
Furthermore, the results of this study were, at least to a degree, skewed. Here’s why. Approximately 8% of those eligible for the study, “did not want to participate because they were in too much pain.” When those who are a great deal of post-accident pain are excluded from the study, the results are not as accurate as they otherwise would be, possibly telling you this problem is less serious than it really is.
“Follow-up assessments were completed at 6 weeks, at 6 months, and at 1 year. At 6 months, 26% of patients had moderate to severe pain that they attributed to the motor vehicle crash, and at least 1 in 4 participants had overall pain symptoms and moderate to severe pain interference with general activities, walking, sleep, and enjoyment of life, attributed to the motor vehicle crash. More than half of participants continued to receive an analgesic (ie, an opioid, acetaminophen, or a non-steroidal anti-inflammatory drug) at 6 months, and 18% were receiving a daily opioid….. 10% of the sample had become long-term opioid users. The frequencies of moderate to severe motor vehicle crash–related pain and pain interference at 1 year were similar to those at 6 months.”
Although we are dealing with CHRONIC NECK PAIN in this post, following close on its heels in this study were Head Pain (not sure if this was HEADACHES OR SKULL PAIN), Chest Pain, Upper Back Pain, and Lower Back Pain. Furthermore, they talk about this sort of pain as having the ability to activate the the Adrenal – Hypothalamus – Pituitary – Adrenal (HPA) Axis, which is the known cause of FIBROMYALGIA, which used to go by the name “ADRENAL FATIGUE“.
“Among older adults discharged home from the ED post-evaluation after a motor vehicle crash, persistent pain is common and frequently associated with functional decline and disability. The observed association between persistent pain and functional decline in our sample suggests that persistent pain is an important determinant of functional decline among older adults experiencing a motor vehicle crash. In contrast, pain was less prevalent and not significantly associated with functional decline among older adults presenting to the ED after falls. This difference suggests that the mechanisms leading to functional decline among older adults presenting to the ED after injury differ,depending on the injury mechanism…… in particular,activation of the hypothalamic – pituitary – adrenal system, may contribute to the transition from acute to persistent pain.”
Here’s the rub. This study goes on to admit that, “Evidence about the ability of established interventions to reduce persistent pain for individuals experiencing motor vehicle crash is conflicting.” They talk about studies showing that neither acupuncture nor active [physical] therapy are very effective. What are the things these authors mention as being a possibility for relieving geriatric pain in older accident victims? Honestly, it sounds like a list born out of sheer desperation.
- PAIN COPING SKILLS: This is simply telling people that it’s going to be alright. They do stop short of recommending playing Bob Marley’s classic reggae hit Everything’s Gonna Be Alright on a continual loop.
- NOVEL THERAPEUTIC AGENTS: Believe me when I tell you that this could be almost any sort of funky drug out there. I would assume that weed might fall under this category as well.
- COGNITIVE BEHAVIORAL THERAPY: Web MD’s Elizabeth Shimer Bowers reveals that, “CBT is a form of talk therapy that helps people identify and develop skills to change negative thoughts and behaviors. CBT says that individuals — not outside situations and events — create their own experiences, pain included. And by changing their negative thoughts and behaviors, people can change their awareness of pain and develop better coping skills, even if the actual level of pain stays the same.” The study we are reviewing today tells us that CBT, “reduces depressive or pain catastrophizing symptoms.” The group they are specifically targeting here are those falling into the category labeled CENTRAL SENSITIZATION.
What would I recommend? Before starting the bullet points above to help with MVA-INDUCED Chronic Neck Pain, I would seriously think about trying these next three bullet points first.
- WORK TOWARD FUNCTIONAL RECOVERY: This should include not only CHIROPRACTIC ADJUSTMENTS (these can be done with an instrument for the elderly) and any number of exercises (keep it all simple), I would strongly recommend dealing with the underlying soft tissue injury by using FASCIAL REMODELING TECHNIQUES as well as some sort of CURVE RESTORATION PROTOCOL.
- COLD LASER THERAPY: Once you understand HOW THIS MODALITY WORKS, it’s a no-brainer. WHOLE BODY VIBRATIONAL THERAPY could provide some tremendous benefits as well.
- DEAL WITH INFLAMMATION: This probably should have been the first bullet point, as there is ample evidence that INFLAMMATION ALWAYS LEADS TO FIBROSIS (Fibrosis is the medical name for “Scar Tissue”). I have tons of information on how to go about accomplishing this point, but before starting, you can take THIS SIMPLE TEST to see if your body is inflamed to begin with.