Widespread pain seen after whiplash in car-crash victims, but not in survivors without whiplash

Janis Kelly

September 01, 2005

September 1, 2005

Edmonton, AB and Manchester, UK - Patients with widespread pain problems often think the pain was triggered by a particular physical trauma, such as a motor-vehicle crash. Crash survivors with whiplash may have subsequent problems not directly related to the neck injury. Two recent papers in the Annals of the Rheumatic Diseases explore these issues.

In the September 2005 issue, Dr Robert Ferrari (University of Alberta, Edmonton) concludes that whiplash-associated disorders (WAD) should be viewed as a systemic illness with long-term detrimental effects on both physical and mental functioning [ 1 ]. "Our findings indicate that the early symptoms experienced by whiplash patients go far beyond neck pain.¿These patients have neck pain, certainly, but more than half also have significant headaches, low back pain, and pain in other parts of their body. In addition, many experience dizziness, nausea, ringing in the ears, jaw pain, fatigue, numbness, and many other diffuse symptoms," Ferrari tells rheumawire .

Our findings indicate that the early symptoms experienced by whiplash patients go far beyond neck pain.

In a related study published online July 13, 2005, Dr Gwenllian Wynn-Jones (University of Manchester, UK) reports that people who have been through a physically traumatic event such as a motor-vehicle crash have no greater risk of developing widespread pain than those who have not experienced a crash [ 2 ].

Whiplash followed by wide range of problems

Ferrari examined a group of 642 subjects drawn from a database of subjects who submitted a claim or were treated for whiplash injury following a motor-vehicle collision over an 18-month period. Of these patients, 45% patients completed the Short Form 36 (SF-36) general health survey at baseline.

Results of the SF-36 "confirm that the illness of whiplash-associated disorders affects both physical and mental health, even in the short term" of one month after injury, the researchers write. The survey of symptoms revealed a wide range of problems extending beyond the chief symptoms of spinal pain. Neck pain and headache were more severe in female patients, who also reported a greater percentage of body pain and were more likely to have nonspinal symptoms such as concentration problems, nausea, dizziness, jaw pain, headache, and hand/arm numbness or pain.

Prevalence of whiplash-associated disorder symptoms

Males (%)
Females (%)
Neck/shoulder pain
Numbness/tingling or pain in arms/hands
Numbness/tingling or pain in legs/feet
Ringing in the ears
Concentration problems
Low back pain

To download table as a slide, click on slide logo below

Both male and female patients reported symptoms such as low back pain, dizziness, nausea, both upper- and lower-limb numbness and tingling, tinnitus, and organic problems. The researchers conclude that "in the acute stages after the injury, persons with whiplash present with a broad range of systemic physical and mental symptoms that cannot be explained by a single anatomical region of injury."

"By the time chronic-pain patients end up before a rheumatologist, their prognosis is grim," Ferrari says. "Rheumatologists should also endeavor not to add to the problem. There is no reasonable evidence that we should explain pain away as a 'facet joint disorder,' as a 'chronic sprain,' 'central hypersensitivity,' or the latest biomedical model of spinal pain. These diagnoses do not help patients but rather engender the belief that one has an incurable problem."

Ferrari says that understanding the whiplash syndrome to be the result of many processes other than simply an acute neck injury allows the clinician to appreciate why some patients undergo transition from acute to chronic pain. "Clinicians can then better appreciate why expectations, depression, coping style, and treatment approaches may engender more pain and distress than is expected from a minor injury. By shifting our treatment focus away from 'healing an injury' to changing expectations, shifting coping styles away from passive styles (medications, ultrasounds, manual therapy, etc), and using function rather than pain relief as an end point, we may be more helpful," he said.

Little evidence that physical trauma triggers widespread pain

Wynne-Jones et al tested the widespread assumption that a physically traumatic event such as a vehicle crash often triggers the onset of widespread musculoskeletal pain. They conducted a prospective cohort study of 597 insurance-company clients in the UK who either did (n=465) or did not (n=132) have a car crash over the study period.

The investigators found the new-onset rates of widespread pain six months after study entry quite low: 8% in the car-crash group vs 6% in the subjects who had not had auto accidents. After adjustment for precrash psychological distress and somatic symptoms, these rates were not significantly different (RR 1.4, 95% CI 0.5-3.2).

"[T]he results of this preliminary study do not provide strong support for physical trauma (at least as exemplified by a motor-vehicle crash) having a large impact on the new onset of widespread pain. It suggests a more modest estimate of the effect of trauma than those previously reported," the authors conclude.



  1. Ferrari R, Russell AS, Carroll LJ, Cassidy JD. A re-examination of the whiplash associated disorders (WAD) as a systemic illness. Ann Rheum Dis 2005; 64:1337-1342.

  2. Wynne-Jones G, Macfarlane GJ, Silman AJ, Jones GT. Does physical trauma lead to an increase in the risk of new onset widespread pain? Ann Rheum Dis 2005; DOI:10.1136/ard.2005.037531.


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