Skip to main content

Advertisement

Log in

Persistent myalgia following whiplash

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Persistent myalgia following whiplash is commonly considered the result of poor psychosocial status, illness behavior, or failing coping skills. However, there is much evidence that persistent myalgia may be due to neurophysiologic mechanisms involving peripheral and central sensitization. Myofascial trigger points may play a crucial role in maintaining sensitization. Recent research suggests that the chemical environment of myofascial trigger points is an important factor. Several consequences are reviewed when central pain mechanisms and myofascial trigger points are included in the differential diagnosis and in the management of patients with persistent pain following whiplash.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Peden M, Scurfield R, Sleet D, et al.: World Report on Road Traffic Injury Prevention. World Health Organization. Geneva: May 3–5, 2004. This is the most comprehensive report on the global impact of motor vehicle accidents and their prevention.

  2. Fallon I, O’Neill D: The world’s first automobile fatality. Accid Anal Prev 2005, 37:601–603.

    Article  PubMed  Google Scholar 

  3. Murray CJ, Lopez AD: Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997, 349:1498–1504.

    Article  PubMed  CAS  Google Scholar 

  4. Lord SM, Barnsley L, Wallis BJ, Bogduk N: Chronic cervical zygapophyseal joint pain after whiplash: a placebo-controlled prevalence study. Spine 1996, 21:1737–1745.

    Article  PubMed  CAS  Google Scholar 

  5. Lidbeck J: Central hyperexcitability in chronic musculoskeletal pain: a conceptual breakthrough with multiple clinical implications. Pain Res Manag 2002, 7:81–92. This paper provides a comprehensive introduction to the implications of sensitization on chronic musculoskeletal pain.

    PubMed  Google Scholar 

  6. Barnsley L, Lord S, Bogduk N: Whiplash injury. Pain 1994, 58:283–307.

    Article  PubMed  CAS  Google Scholar 

  7. Radanov BP, Sturzenegger M, Di Stefano G: Long-term outcome after whiplash injury: a 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings. Medicine (Baltimore) 1995, 74:281–297.

    Article  CAS  Google Scholar 

  8. Satoh S, Naito S, Konishi T, et al.: An examination of reasons for prolonged treatment in Japanese patients with whiplash injuries. J Musculoskeletal Pain 1997, 5:71–84.

    Article  Google Scholar 

  9. Lovell ME, Galasko CS: Whiplash disorders: a review. Injury 2002, 33:97–101.

    Article  PubMed  CAS  Google Scholar 

  10. Ameratunga SN, Norton RN, Bennett DA, Jackson RT: Risk of disability due to car crashes: a review of the literature and methodological issues. Injury 2004, 35:1116–1127.

    Article  PubMed  Google Scholar 

  11. Andersson AL, Bunketorp O, Allebeck P: High rates of psychosocial complications after road traffic injuries. Injury 1997, 28:539–543.

    Article  PubMed  CAS  Google Scholar 

  12. Schrader H, Obelieniene D, Bovim G, et al.: Natural evolution of late whiplash syndrome outside the medicolegal context. Lancet 1996, 347:1207–1211.

    Article  PubMed  CAS  Google Scholar 

  13. Awerbach MS: Whiplash in Australia: illness or injury. Med J Aust 1992, 157:193–196.

    Google Scholar 

  14. Ferrari R, Russell AS: Epidemiology of whiplash: an international dilemma. Ann Rheum Dis 1999, 58:1–5.

    Article  PubMed  CAS  Google Scholar 

  15. Brison RJ, Hartling L, Pickett W: A prospective study of acceleration-extension injuries following rear-end motor vehicle collisions. J Musculoskeletal Pain 2000, 8:97–113.

    Article  Google Scholar 

  16. Croft AC: The case against “litigation neurosis” in mild brain injuries and cervical acceleration/deceleration trauma. JNMS 1993, 1:149–155.

    Google Scholar 

  17. Freeman MD, Croft AC: The controversy over late whiplash: are chronic symptoms after whiplash real? In Whiplash Injuries: Current Concepts in Prevention, Diagnosis, and Treatment of the Cervical Whiplash Syndrome. Edited by Gunzburg R, Szpalski M. Philadelphia: Lippincott-Raven; 1998:161–165.

    Google Scholar 

  18. Freeman MD, Croft AC, Rossignol AM, et al.: A review and methodologic critique of the literature refuting whiplash syndrome. Spine 1999, 24:86–96.

    Article  PubMed  CAS  Google Scholar 

  19. Hodgson SP, Grundy M: Whiplash injuries: their long-term prognosis and its relation to compensation. Neurol Orthop 1989, 7:88–91.

    Google Scholar 

  20. Bicik I, Radanov BP, Schafer N, et al.: PET with 18fluorodeoxyglucose and hexamethylpropylene amine oxime SPECT in late whiplash syndrome. Neurology 1998, 51:345–350.

    PubMed  CAS  Google Scholar 

  21. Duckworth MP, Iezzi T: Chronic pain and posttraumatic stress symptoms in litigating motor vehicle accident victims. Clin J Pain 2005, 21:251–261.

    Article  PubMed  Google Scholar 

  22. Sterling M, Kenardy J, Jull G, Vicenzino B: The development of psychological changes following whiplash injury. Pain 2003, 106:481–489. This is an excellent study exploring the onset of psychologic problems following whiplash.

    Article  PubMed  Google Scholar 

  23. Wallis BJ, Lord SM, Bogduk N: Resolution of psychological distress of whiplash patients following treatment by radiofrequency neurotomy: a randomized, double-blind, placebo-controlled trial. Pain 1997, 73:15–22.

    Article  PubMed  CAS  Google Scholar 

  24. Karlsborg M, Smed A, Jespersen H, et al.: A prospective study of 39 patients with whiplash injury. Acta Neurol Scand 1997, 95:65–72.

    PubMed  CAS  Google Scholar 

  25. Dommerholt J, Royson MW, Whyte-Ferguson L: Neck pain and dysfunction following whiplash. In Clinical Mastery of Myofascial Pain Syndrome. Edited by Whyte-Ferguson L, Gerwin RD. Baltimore: Lippincott, Williams & Wilkins; 2005:57–89.

    Google Scholar 

  26. Freeman MD: Don’t fall for defense fallacies. Trial 2000, November:88–93.

    Google Scholar 

  27. Klobas L, Tegelberg A, Axelsson S: Symptoms and signs of temporomandibular disorders in individuals with chronic whiplash-associated disorders. Swed Dent J 2004, 28:29–36.

    PubMed  Google Scholar 

  28. Bergman H, Andersson F, Isberg A: Incidence of temporomandibular joint changes after whiplash trauma: a prospective study using MR imaging. AJR Am J Roentgenol 1998, 171:1237–1243.

    PubMed  CAS  Google Scholar 

  29. Svensson P, Graven-Nielsen T: Craniofacial muscle pain: review of mechanisms and clinical manifestations. J Orofac Pain 2001, 15:117–145. The authors provide a very comprehensive overview of pain mechanisms in the craniomandibular region.

    PubMed  CAS  Google Scholar 

  30. Kumar S, Narayan Y, Amell T: Analysis of low-velocity frontal impacts. Clin Biomech (Bristol, Avon) 2003, 18:694–703.

    Article  Google Scholar 

  31. Schuller E, Eisenmenger W, Beier G: Whiplash injury in lowspeed car accidents. J Musculoskeletal Pain 2000, 8:55–67.

    Article  Google Scholar 

  32. Sterling M, Jull G, Vicenzino B, et al.: Physical and psychological factors predict outcome following whiplash injury. Pain 2005, 114:141–148. Reports that identifying people at risk for chronic problems as soon as possible is of great importance.

    Article  PubMed  Google Scholar 

  33. Jull GA: Deep cervical flexor muscle dysfunction in whiplash. J Musculoskeletal Pain 2000, 8:143–154.

    Article  Google Scholar 

  34. Nederhand MJ, Hermens HJ, Ijzerman MJ, et al.: Chronic neck pain disability due to an acute whiplash injury. Pain 2003, 102:63–71.

    Article  PubMed  Google Scholar 

  35. Sterling M, Jull G, Vicenzino B, et al.: Development of motor system dysfunction following whiplash injury. Pain 2003, 103:65–73. Research study that explores the onset of motor dysfunction in whiplash victims.

    Article  PubMed  Google Scholar 

  36. Scott D, Jull G, Sterling M: Widespread sensory hypersensitivity is a feature of chronic whiplash-associated disorder, but not chronic idiopathic neck pain. Clin J Pain 2005, 21:175–181.

    Article  PubMed  Google Scholar 

  37. Kasch H, Qerama E, Bach FW, Jensen TS: Reduced cold pressor pain tolerance in non-recovered whiplash patients: a 1-year prospective study. Eur J Pain 2005, in press.

  38. Johansen MK, Graven-Nielsen T, Schou Olesen A, Arendt-Nielsen L: Generalised muscular hyperalgesia in chronic whiplash syndrome. Pain 1999, 83:229–234.

    Article  Google Scholar 

  39. Banic B, Petersen-Felix S, Andersen OK, et al.: Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain 2004, 107:7–15.

    Article  PubMed  Google Scholar 

  40. Curatolo M, Arendt-Nielsen L, Petersen-Felix S: Evidence, mechanisms, and clinical implications of central hypersensitivity in chronic pain after whiplash injury. Clin J Pain 2004, 20:469–476. Excellent study supporting the main message of this article; which is that central sensitization is a common phenomenon following whiplash injuries.

    Article  PubMed  Google Scholar 

  41. Curatolo M, Petersen-Felix S, Arendt-Nielsen L, et al.: Central hypersensitivity in chronic pain after whiplash injury. Clin J Pain 2001, 17:306–315.

    Article  PubMed  CAS  Google Scholar 

  42. Munglani R: Neurobiological mechanisms underlying chronic whiplash associated pain: the peripheral maintenance of central sensitization. J Musculoskeletal Pain 2000, 8:169–178.

    Article  Google Scholar 

  43. Herren-Gerber R, Weiss S, Arendt-Nielsen L, et al.: Modulation of central hypersensitivity by nociceptive input in chronic pain after whiplash injury. Pain Med 2004, 5:366–376. This is a recent update of previous papers and supports the notion that ongoing peripheral input may be required for central sensitization.

    Article  PubMed  Google Scholar 

  44. Quinlan KP, Annest JL, Myers B, et al.: Neck strains and sprains among motor vehicle occupants: United States, 2000. Accid Anal Prev 2004, 36:21–27.

    Article  PubMed  Google Scholar 

  45. Simons DG: Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol 2004, 14:95–107.

    Article  PubMed  Google Scholar 

  46. Gerwin RD, Shannon S, Hong CZ, et al.: Interrater reliability in myofascial trigger point examination. Pain 1997, 69:65–73.

    Article  PubMed  CAS  Google Scholar 

  47. Sciotti VM, Mittak VL, DiMarco L, et al.: Clinical precision of myofascial trigger point location in the trapezius muscle. Pain 2001, 93:259–266.

    Article  PubMed  CAS  Google Scholar 

  48. Dommerholt J: Dry needling in orthopedic physical therapy practice. Orthop Phys Ther Practice 2004, 16:15–20.

    Google Scholar 

  49. Simons DG, Travell JG, Simons LS: Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual, edn 2, vol 1. Baltimore: Williams & Wilkins; 1999.

    Google Scholar 

  50. Gerwin RD, Dommerholt J: Myofascial trigger points in chronic cervical whiplash syndrome. J Musculoskeletal Pain 1998, 6(suppl 2):28.

    Google Scholar 

  51. Simons DG: Triggerpunkte und myogelose. Manuelle Medizin 1997, 35:290–294.

    Article  Google Scholar 

  52. Baker BA: The muscle trigger: evidence of overload injury. J Neurol Orthop Med Surg 1986, 7:35–44.

    Google Scholar 

  53. Quintner JL, Cohen ML: Referred pain of peripheral nerve origin: an alternative to the “myofascial pain” construct. Clin J Pain 1994, 10:243–251.

    Article  PubMed  CAS  Google Scholar 

  54. Bendtsen L, Jensen R, Olesen J: Qualitatively altered nociception in chronic myofascial pain. Pain 1996, 65:259–264.

    Article  PubMed  CAS  Google Scholar 

  55. Gerwin RD, Dommerholt J: Treatment of myofascial pain syndromes. In Pain Management: A Practical Guide for Clinicians. Edited by Weiner RS. Boca Raton: CRC Press; 2002:235–249.

    Google Scholar 

  56. Shah J, Phillips TM, Danoff JV, Gerber LH: An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol 2005, in press.

  57. Gerwin RD, Dommerholt J, Shah J: An expansion of Simons’ integrated hypothesis of trigger point formation. Curr Pain Headache Rep 2004, 8:468–475.

    PubMed  Google Scholar 

  58. Fernández de las Peñas C, Campo MS, Carnero JF, Page JC: Manual therapies in myofascial trigger point treatment: a systematic review. J Bodywork Movement Ther 2005, 9:27–34.

    Article  Google Scholar 

  59. Fernández de las Peñas C, Fernández-Carnero J, Palomeque del Cerro L, Miangolarra-Page JC: Manipulative treatment vs. conventional physiotherapy treatment in whiplash injury: a randomized, controlled trial. J Whiplash Related Disorders 2004, 3:73–90.

    Article  Google Scholar 

  60. Alpass L: Chiropractic management of ‘intractable’ chronic whiplash syndrome. Clin Chiropractic 2004, 7:16–23.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dommerholt, J. Persistent myalgia following whiplash. Current Science Inc 9, 326–330 (2005). https://doi.org/10.1007/s11916-005-0008-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-005-0008-5

Keywords

Navigation