Most whiplash patients end treatment when legal action finished

More than 90 per cent of patients with whiplash attending a Dublin pain management clinic failed to return for additional treatment once their legal action was completed.

The unpublished finding, from a study of 100 patients of the Mater Hospital pain management service, is quoted in a paper by two leading neurosurgeons as evidence Ireland is experiencing "a whiplash epidemic" requiring urgent reform.

Jack Phillips and Ciarán Bolger, neurosurgeons at Beaumont Hospital in Dublin, describe whiplash as a "concept" surrounded by "myths" not based on scientific evidence.

People who suffer whiplash injuries in sport – or who do not take legal action – recover in six to 12 weeks, and are advised to “act as usual and return to play”, they point out.

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In contrast, people taking cases over whiplash injuries suffer a “perfect storm”, due to protracted litigation that can last years. Advised to rest, they are prescribed opiates and other pain medicines and may suffer early post-traumatic stress disorder.

The doctors say such patients are at risk of addiction, early post-traumatic stress disorder, “misinterpreted” MRIs and repeated pain-management treatment with no designated end-point.

As a result, they say, litigants may lose their jobs, suffer family distress and become addicted to opiates.

Culturally dependent outcome

Their findings were presented at the recent European Association of Neurosurgical Societies conference in Dublin. In a subsequent discussion, other neurosurgeons said whiplash was far less prevalent in the European countries where they practised.

Asked whether whiplash was a real phenomenon, Mr Phillips told The Irish Times “it is both fact and fiction; the original injury is factual but there is a fictitious element that leads to chronic presentations”.

Describing litigants as “victims”, he said the evidence “points to an alleged injury syndrome which is present in Western societies with a culture of legal action”.

The outcome of whiplash injury is “culturally dependent”, the doctors say, with few lasting symptoms in countries such Germany, Greece or Lithuania where compensation is not generally available.

In Lithuania, for example, where possibilities for gain are “minimal”, a study of 202 people involved in rear-end collisions shows none had persisting and disabling complaints one to two years later. Another study of 210 people showed symptoms disappeared in most cases after a few days.

Between 2006 and 2017, the number of personal injury awards grew by 127 per cent, while the value of claims increased by 174 per cent, according to the paper. Average awards are three times higher than in the UK, and more than five times higher than in continental Europe.

The Irish doctors, who regularly assess patients for whiplash injuries, point out that engineering reports prepared for court cases frequently question the severity of symptoms following whiplash injuries, “particularly where accidents occur at roundabout with slowing speeds varying between 5-10km an hour”.

“Equally mystifying is the absence of injury to the rear-ending driver, despite the impact of equal and opposite forces.”

‘Unfortunate consequences’

Another myth is that many treatments work. “The concept of evidence-based medicine is rarely applied to whiplash injury claimants,” they say. “Medical therapists in all forms portray the acute whiplash injury as an injury that requires assistance in healing. Words like ‘inflammation’, ‘tightness’, ‘trigger points’, ‘subluxation’, etc are loosely used by various therapists.”

Over 90 per cent of people involved in litigation following whiplash injuries are referred for pain management, they note. Some become dependent on the opiates they are prescribed at the expense of their quality of life.

“Borrowing treatment principles from acute and end-of-life pain, particularly a focus on pain intensity scores, has had unfortunate and harmful consequences, including opiate addiction.”

Many other treatments are not supported by modern, evidence-based medicine, they say. “Frequently, litigants appear to be unaware of the precise invasive therapies being employed or the potential benefits or complications associated with spinal-cord stimulation.”

Drawing on Canadian research, the two doctors suggest the many symptoms and psychological factors linked to whiplash suggest “a systemic illness behaviour … determined less by the etiology (cause) of the injury and more globally by an environment that encouraged a recognisable illness behaviour which evolved regardless of the initial pathology”.

They also cited a study of the patients of a Galway spinal surgeon, which found only 10 out of 301 were seen in his clinic after their litigation had finished.