Pharmacological and Interventional Management of Pain After Whiplash Injury

Curatolo, Michele

doi:10.2519/jospt.2016.6906

Cited by 17 publications

(13 citation statements)

References 45 publications

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“…There is no high level evidence on the effectiveness of medication for the management of WAD, with a recent review finding no RCTs which supported the use of any medication for WAD [ 11 ]. Based on consensus, Clinical Practice Guidelines for the management of acute WAD recommend “ regular paracetamol and if this is ineffective, then NSAIDS may be used.…”

Section: Discussionmentioning

confidence: 99%

“…Following general pain management guidelines is recommended when prescribing medication for these patients. This recommendation is consensus based because there is sparse evidence on the pharmacologic treatments for WAD [ 11 ]. “ Simple analgesics may be used as first line treatment for pain relief.…”

Section: Introductionmentioning

confidence: 99%

“…Ongoing need for such treatment requires reassessment [ 10 ]. ” No available evidence supports the use of paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or opioids in the management of WAD [ 11 ]. The latter two drugs, in particular, need to be used cautiously because of the potential for adverse events, particularly in the elderly.…”

Section: Introductionmentioning

confidence: 99%

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Management of Whiplash Associated Disorders in Australian general practice

Nikles

Yelland

Bayram

et al. 2017

BMC Musculoskelet Disord

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BackgroundWhiplash Associated Disorders (WAD) are common and costly, and are usually managed initially by general practitioners (GPs). How GPs manage WAD is largely unstudied, though there are clinical guidelines. Our aim was to ascertain the rate of management (percentage of encounters) of WAD among patients attending Australian general practice, and to review management of these problems, including imaging, medications and other treatments.MethodsWe analysed data from 2013 to 2016 collected by different random samples of approximately 1000 general practitioners (GPs) per year. Each GP collected data about 100 consecutive consultations for BEACH (Bettering the Evaluation and Care of Health), an Australian national study of general practice encounters.Main outcome measures were: the proportion of encounters involving management of WAD; management including imaging, medications and other treatments given; appropriateness of treatment assessed against published clinical guidelines.ResultsOf 291,100 encounters from 2919 GP participants (a nationally representative sample), WAD were managed at 137 encounters by 124 GPs (0.047%). Management rates were 0.050% (females) and 0.043% (males). For 63 new cases (46%), 19 imaging tests were ordered, most commonly neck/cervical spine x-ray (52.6% of tests for new cases), and neck/cervical spine CT scan (31.6%). One or more medications were prescribed/supplied for 53.3% of WAD. NSAIDs (11.7 per 100 WAD problems) and compound analgesics containing paracetamol and opioids (10.2 per 100 WAD problems) were the commonest medications used by GPs overall. Paracetamol alone was used in 8 per 100 WAD problems. The most frequent clinical/procedural treatments for WAD were physical medicine/rehabilitation (16.1 per 100 WAD problems), counselling (6.6), and general advice/education (5.8).ConclusionsGPs refer about 30% of new cases for imaging (possibly overutilising imaging), and prescribe a range of drugs, approximately 22% of which are outside clinical guidelines. These findings suggest a need for further education of GPs, including indications for imaging after whiplash injury, identification of those more likely to develop chronic WAD, and medication management guidelines. WAD carry a large personal and economic burden, so the impact of improvements in GP management is potentially significant.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of Whiplash Associated Disorders in Australian general practice

Nikles

Yelland

Bayram

et al. 2017

BMC Musculoskelet Disord

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“…The effectiveness of medication in the early treatment of whiplash has been flagged as an urgent research need for several years [ 13 ], including at the International Summit on Whiplash Injury in 2011 [ 14 ]. Our analysis of data from the multi-year Bettering the Evaluation and Care of Health (BEACH) study of General Practitioner (GP) activity in Australia found that medications are prescribed for most whiplash cases [ 15 ], yet a recent review found no studies to support the effectiveness of any medication for whiplash-associated disorders (WAD) [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Pregabalin versus placebo in targeting pro-nociceptive mechanisms to prevent chronic pain after whiplash injury in at-risk individuals – a feasibility study for a randomised controlled trial

Nikles

Keijzers

Mitchell

et al. 2018

Trials

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BackgroundWhiplash-associated disorders (WAD) are an enormous and costly burden to Australian society. Up to 50% of people who experience a whiplash injury will never fully recover. Whiplash is resistant to treatment and no early management approach has yet been shown to prevent chronic pain. The early presence of central sensitization is associated with poor recovery. Pregabalin’s effects on central sensitization indicate the potential to prevent or modulate these processes after whiplash injury and to improve health outcomes, but this has not been investigated. This paper describes the protocol for a feasibility study for a randomised controlled trial of pregabalin plus evidence-based advice compared to placebo plus evidence-based advice for individuals with acute whiplash injury who are at risk of poor recovery.MethodsThis double blind, placebo-controlled randomised feasibility study will examine the feasibility and potential effectiveness of pregabalin and evidence-based advice (intervention) compared to placebo and evidence-based advice (control) for individuals with acute whiplash injury at risk of poor recovery. Thirty participants (15 per group) aged 18–65 years with Grade II WAD, within 48 hours of injury and currently experiencing at least moderate pain (NRS: ≥ 5/10) will be recruited from Emergency Departments of public hospitals in Queensland, Australia. Pregabalin will be commenced at 75 mg bd and titrated up to 300 mg bd as tolerated for 4 weeks followed by 1 week of weaning.ResultsThe feasibility of trial procedures will be tested, as well as the potential effect of the intervention on the outcomes. The primary outcome of neck pain intensity at 3 months from randomisation will be compared between the treatment groups using standard analysis of variance techniques.DiscussionFeasibility and potential effectiveness data will inform an appropriately powered full trial, which if successful, will provide an effective and cost-effective intervention for a costly and treatment resistant condition. It will also have implications for the early management of other traumatic conditions beyond whiplash.Trial registrationClinical Trials Primary Registry: Australian and New Zealand Clinical Trials Registry.Clinical Trial Registration Number: ACTRN12617000059369.Date of Registration: 11/01/2017.Primary Trial Sponsor: The University of Queensland, Brisbane QLD 4072 Australia.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2450-9) contains supplementary material, which is available to authorized users.

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“…This special issue presents several relevant commentaries that present the current thoughts in this area. 5,6,20 Decisions made in the emergency department regarding possible diagnosis and the timing and means of the imaging used are important. 5 In conjunction with debate on the use of conventional imaging, the potential use of a wider scope of imaging technology is discussed to understand possible changes that might occur centrally and/or peripherally with pain and injury.…”

mentioning

confidence: 99%

Whiplash Continues Its Challenge

Jull¹

2016

J Orthop Sports Phys Ther

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There have been many advances in the management of neck pain disorders, but a personal frustration as a clinician and researcher in the field is that the incidence of full recovery following a whiplash injury as a result of a motor vehicle crash has not increased and, subsequently, the rate of transition to chronic neck pain has not lessened. The commentaries in this special issue reflect the multifaceted nature of whiplash-associated disorders and the wide-ranging research in the field. While management of whiplash, especially the challenge of lessening the rate of transition to chronicity, has yet to be achieved, the picture is becoming clearer. This should give great confidence and some hope to individuals with whiplash-associated disorders who have long-term pain and functional disability that after the next decade of research and clinical development, the outcomes following whiplash are likely to be vastly improved. J Orthop Sports Phys Ther 2016;46(10):815-817. doi:10.2519/jospt.2016.0112.

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Pharmacological and Interventional Management of Pain After Whiplash Injury

Cited by 17 publications

References 45 publications

Management of Whiplash Associated Disorders in Australian general practice

Management of Whiplash Associated Disorders in Australian general practice

Pregabalin versus placebo in targeting pro-nociceptive mechanisms to prevent chronic pain after whiplash injury in at-risk individuals – a feasibility study for a randomised controlled trial

Whiplash Continues Its Challenge

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