Sites from which whiplash injury pain (acute neck sprain) may arise include myofascial trigger points (MTrPs), facet joints and the intervertebral discs. There are various methods of deactivating MTrPs; that recommended is superficial dry needling. Pain referral patterns from facet joint and MTrP nociceptors are similar, so failure to obtain appreciable pain relief from MTrP deactivation necessitates a diagnostic, fluoroscopically controlled, facet joint block. Disc pain may occur either because of damage to the innervated annulus fibrosus of an intact disc, or because of nerve root pressure when a disc ruptures. Most whiplash patients (75%) become pain free within 3–6 months. The remainder are said to have the late whiplash syndrome. This was formerly thought to be due to neuroticism or compensation seeking avarice, but it is currently considered to have a genuine organic basis. Possible causes include overlooked facet joint damage, undetected disc damage and various self perpetuating MTrP pain persisting mechanisms.
The late whiplash syndrome: a biopsychosocial approach
