You've probably heard someone claim, "…you’re not really injured – you’re just going for a big settlement!" Or, "…that person isn’t really hurt, they’re just in it for the money!" Though there are cases that may fit this scenario, the majority of people who are injured in a motor vehicle collision would gladly forfeit any settlement to have their health and sometimes their life back. So, where in this process does the truth lie? Do most people "fake" their complaints or are they really in pain? And, is there a way to determine who is more likely to suffer with problems long after their case is settled?
To answer this question, the Quebec Task Force (QTF) published two studies to investigate what types of whiplash injuries, which they term "whiplash associated disorders" (WAD), sustained in a rear end or side impact motor vehicle collision might end up with no residual injury vs. those more likely to become permanently disabled or impaired. The first of the two studies published in 1995 introduced 3 categories of injuries:
- Those with neck pain, stiffness or tenderness only - no clinical (exam) findings;
- Neck complaints and clinical findings including decreased ranges of neck motion;
- Neck complaints and loss of neurological function including numbness or weakness in arm strength and/or altered reflexes.
The QTF then set out to investigate whether this approach could indeed accurately predict those more vs. less likely to end up with significant disability with ongoing problems. They published these results in 2001 and found if they broke down the 2nd category into two groups, those with vs. without neck motion loss, those patients who fell into the 2nd group (with neck motion loss) and the 3rd group (those with neurological signs) were more likely to suffer long-term disability compared with those in groups 1 and 2a (without neck motion loss). However, these conclusions have been challenged by many as being too simple because they do not include the psychological problems like depression, anxiety, and poor coping abilities, all of which play an important role in predicting long-term disability. Also, treatment strategies must include aspects to deal with the post-traumatic stress disorder, anxiety, depression, and coping, not just the biological injury aspects. A convincing study published in 2008 looked at 226 studies on this subject and reported on 7 prognostic factors and found that 50-75% of people with current neck pain will report neck pain again 1-5 years later. Older age and psychosocial factors including psychological health, coping patterns, and the need to socialize were the strongest predictors. Three other potential predictors that require more investigation include the presence of arthritis, genetic factors, and compensation policies.
The bottom line or best advice to minimize our chances of having chronic, disabling neck pain after a car crash is, don’t stop living! That is to say, carry on with work and hobbies as much as you possibly can so that you don’t fall into the negative spiral of disability. If you feel yourself slipping, get help sooner rather than later! Pain relief and function restoration are strong goals and chiropractic has been found to be one of the first and most effective forms of treatment recommended by all treatment guidelines published on whiplash management. Comparing potential side effects, medications carry a significant list of negative effects while chiropractic carries very few and a host of positive benefits.
