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A right pain in the neck

Last weekend I was rear ended and my sturdy 2006 Volvo V-70, which I had planned on driving for another few years, was written off. As I got out of the car, I became aware that my neck was painful but naturally declined an onlooker’s offer of calling for an ambulance. The embarrassing prospect of being placed in a cervical collar and being presented to an emergency department colleague on a stretcher did not appeal to me. Besides, I had to drop my daughter to a party.

The fact that I might have injured my neck caused some concern (and some mirth) amongst family members, who could still clearly recall my first whiplash injury — almost 40 years earlier. Having sustained what was, in retrospect, a minor neck strain (following a jump from a wall), I awoke the following day with such severe neck pain that my parents were unable to persuade me to get out of bed. The local GP was called, strong painkillers, muscle relaxants and a neck collar were prescribed and over the next few days my home bedroom was gradually converted, my younger brother recalls, into a temporary intensive care unit.

My physical and considerable emotional needs were carefully attended to by my attentive parents, my fluid balance restored with MiWadi infused through a bendy straw and my nutrition maintained with jelly and ice cream. After a time, and once I felt well enough to lift my head from the pillow, I was transferred to a lower-dependency unit located in the family TV room. After a further, lengthy period of rehabilitation, it was considered safe to allow me to return to school. My neck pain continued and over next few years, I would travel around the country see the best physiotherapists, orthopaedic surgeons and rheumatologists in the land. The advice I received from more than one specialist was that I needed to be very careful with my neck, pay extra attention to my posture and avoid contact sport at all costs.

Despite medical interventions (and perhaps precisely because they had stopped), my neck pain eventually settled. The experience, however, has given me a unique insight into my own low threshold for unpleasantness, some understanding of the non-medical dynamics of chronic pain and how completely unaware most of us are of them as sufferers.

It therefore came as a pleasant surprise that my most recent whiplash injury settled down within a few days. Could I have toughened up?

A quick Google search alerted me to a possible explanation for my speedy recovery: Doctors, it appears, are relatively immune to the long-term effects of neck injuries following rear-end collisions. A study by Ferrari published in 2001 examined the effects of whiplash injury in doctors compared to a control population. Doctors developed acute symptoms less frequently than non-doctors and injured doctors settled down more quickly than controls. They were also quicker to return to work after an injury.

The author’s proposal was that the development of chronic neck pain after a road traffic accident is largely culturally and geographically determined and that these factors are much more important than the mechanism and severity of the initial injury. Where there isn’t an expectation of the development of chronic neck pain after an accident, he argued, then it is much less likely to occur.

In ordinary circumstances, Ferrari detailed in his book The Whiplash Encyclopaedia — The Facts and Myths of Whiplash, the often frightening circumstances surrounding the initial management of a neck injury (paramedics, collars, stretchers and EDs) tend to create the impression than the injury is not benign.

The initial lack of response to treatment by various therapists and specialists (where attention is repeatedly drawn to the symptoms), and subsequent frequent misattribution of symptoms to abnormalities seen on imaging, all tend to further amplify and reinforce the apparent seriousness of the injury. The additional influence of compensation, he argued (the MiWadi, jelly and ice cream of my own experience) can lead to worse outcomes. He pointed out that in countries where ‘no-fault compensation’ has been introduced (and where financial compensation for continued suffering was removed), the incidence and severity of chronic symptoms in this setting has improved.

Most people injured in this setting will be oblivious, as I was, to the influence that all of these factors will have on perpetuation of their symptoms.

It makes sense, though, that doctors are less likely, by the nature of their training and knowledge, to be susceptible to these influences, or to be fortunate enough to avoid exposure to them in the first place. Ferrari has also published similar positive and early recovery outcomes in rodeo riders who have been involved in road traffic accidents — another group with an expectation, based on personal experience, that neck sprains are pretty common and will usually settle down.

As I write, I feel a twinge of pain in my neck. Maybe I should have an MRI scan…

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