In the pursuit of proof of brain damage after whiplash injury

Whiplash is the commonly applied term for sprain or strain of the cervical region caused by sudden flexion-extension movements, most typically as a result of rear-end collisions. A specific diagnosis such as fracture, dislocation, herniated disc, root or plexus injury, or spinal cord injury overrides a diagnosis of whiplash. Thus, patients with whiplash do not have overt structural abnormalities. The forceful flexion-extension injury may damage cervical muscles, longitudinal vertebral ligaments, capsules of the facet joints, or the intervertebral discs. Whiplash causes neck pain, headache, and a variety of upper extremity regional pain or paresthetic symptoms either referred or possibly due to plexus compression by injured muscles. In most patients, pain gradually decreases over days to weeks, and by 6 months most patients are asymptomatic.1 Early treatment may utilize brief immobilization (collar), a short course of muscle relaxants, anti-inflammatory analgesics (aspirin or nonsteroidal anti-inflammatory drugs [NSAIDs]), heat and ultrasound begun after a few days, massage, gradual mobilization, and strengthening. A cervical pillow may prevent inadvertent exacerbation due to poor positioning during sleep. A variety of nontraditional treatments are often used, mostly chiropractic and acupuncture. The exact, best treatment is not known. A minority of patients have persistent or worsening pain despite treatment. The causes of persistent symptoms-chronic whiplash-are unknown. Pearce waded into this controversy in an editorial in Neurology in 1994, concluding that there was little evidence for a structural basis for chronic whiplash.2 Subsequent correspondence was vitriolic: polemics, doctrines, promotion of confusion, liars, malingerers, hysterics, neurotics, and egregious errors were mentioned. In his response, Dr. Pearce parried these thrusts skillfully, although there must have been some superficial flesh wounds.3 Chronic whiplash may "evolve" into fibromyalgia, a diagnosis by committee that inflames the extremists and leaves no unscorched ground for the moderates.4,5 Some patients also have cognitive …