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Spring 2021
In this issue we discuss the causes, diagnosis, and treatments for cervical whiplash injures. Cervical Whiplash Associated Disorder
Background Whiplash associated disorder Symptoms such as neck pain, (WAD) involves an injury to the shoulder pain, arm pain, and Pictured below is Dr. neck. It is characterized by a headache may be present Provenzano teaching at collection of symptoms that directly after the injury or may the 46th Annual Regional occur following a sudden be delayed for several days. Anesthesiology and Acute extension and flexion injury. Other symptoms may include Pain Medicine Meeting in The injury commonly occurs as neck stiffness, muscle Orlando Florida. He the result of an automobile (myofascial) pain, dizziness, lectured on the accident and may involve the and abnormal sensations such intervertebral joints, discs, as burning or tingling in the development of new guidelines to reduce the ligaments, cervical muscles, arms. risk of infection. and nerve roots.
Diagnosis Generally, physicians will employ Additional testing, (e.g., X-rays, a physical exam including a MRI, and EMG/NCS) may be neurological exam, along with a warranted in the diagnosis of a patient’s history, to make a WAD WAD; especially, if the patient diagnosis. Clinical signs of presents with significant whiplash include spasms, neurological signs. tenderness, and limited range of motion of the neck.
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Recent Publication Prognosis Generally, the prognosis for a Unfortunately, a small subset of WAD is favorable. The neck and people, 15-30%, continue to have head pain often clears within a pain for several months or years few days or weeks. Most after the injury. patients, 85%, recover within 6 WAD progress through the months after the injury, following stages: however, some may continue to have residual neck pain, • Acute WAD: < 3 weeks neurological symptoms, and • Subacute WAD: ≥ 3 weeks headaches. to 3 months • Chronic WAD: > 3 months
Treatments Dr. Provenzano and At Pain Diagnostics and minimally invasive interventions Samuel Florentino, Interventional Care, we take a may be employed such as former CRC, recently had multimodal approach to cervical epidural steroid an article published in treating WAD which may injections to help reduce nerve Regional Anesthesia and include physical and tissue inflammation, cervical Pain Medicine Journal. therapy/chiropractic care, facet procedures (injections and Their article focused on nonopioid medication radiofrequency ablation) to the examination of management and minimally provide joint pain relief, and radiation safety and invasive interventions. trigger point injections to help knowledge among irritated muscles. Facet joints interventional pain Treatment depends on the severity of the symptoms. If the may be injured in WAD. In physicians. patients that have symptoms for symptoms are mild to moderate rest, ice/heat, and over-the- greater than 6 months with Mission Statement confirmed facet pain, To professionally and counter medications are often effective. If patients do not radiofrequency ablation maybe passionately provide considered. evidence-based medical improve with conservative care for patients with management strategies, then various pain states and to advance the science Recent/Upcoming Lectures of pain medicine through 46th Annual Regional North American Neuromodulation research and education. Anesthesiology and Acute Pain Society The 2021 Mid-Year Meeting Medicine Meeting July 15-17, 2021 Vision Statement May 13-15, 2021 Lecturing on healthcare policy, To be recognized and -Lectured on practice spinal cord stimulation, radiation celebrated as the gold management and value-based safety. standard for pain care and strategies to reduce The SIS Annual Meeting medicine in the greater infections August 18-21, 2021 Pittsburgh region. International Neuromodulation Lecturing on advances in spinal cord Society (INS) stimulation programming June 2021 Radiation safety for interventional pain physicians