In Brief

Patients with whiplash who watched a brief educational video about muscle pain in the emergency room experienced dramatically lower levels of pain than those who followed traditional treatment recommendations, found a recent study in the journal SPINE (Vol. 31, No. 15, 1652–1657).

The trial involved 126 patients from the Orange County area who went to the emergency room or an urgent care center for treatment after a whiplash injury and were diagnosed with neck strain by a physician. All participants received standard advice to use over-the-counter analgesics for pain, to apply ice and heat to the affected areas and to follow up with their personal physicians, but half of the participants also watched a pain-management video developed by the study's authors, who are affiliated with the Sharp Pain Rehabilitation and the Myopoint Pain clinics in San Diego.

The video describes the progression from acute to chronic muscular pain, according to psychologist Richard Gevirtz, PhD, one of the study's authors, and a health psychology professor at Alliant University in San Diego. In their work at the pain clinics, Gevirtz and his fellow authors, psychologist Ali Oliveira, PhD, and neurologist David Hubbard, MD, have focused on muscular "trigger points" that are wired to the sympathetic nervous system, and thus closely tied to stress reactions, he says. The video shows how stress can feed the pain, Gevirtz says.

"The theory on whiplash is that pain beyond the acute stage produces stressful cognition, which produces more pain, which causes stress, and it becomes a vicious cycle," he explains. In addition to helping patients understand the pain process, the video also teaches them stretching exercises and stress-relief techniques such as deep breathing, says Gevirtz.

The researchers followed up by phone with participants in both the control and video group at one, three and six months post-treatment and asked them to rate their pain using a standard self-report measure. Those in the video group gave dramatically lower pain ratings at the one-month mark. On a scale of zero to 10, the video group rated their pain at an average of 1.5, while the control group rated theirs at an average of five. This pattern held throughout the six months. What's more, at the six-month mark, only 4 percent of the video group reported using narcotics, as compared with 36 percent of the control group.

"We believe that as soon as people understand the cycle, it greatly reduces the perception of catastrophic pain," says Gevirtz. The team plans to try and replicate its success with people who have chronic back pain.

-L. Meyers

Further Reading

For more information about using psychology to help treat chronic back pain, see Block, A.R., Gatchel, R.J., Deardorff, W.W. and Guyer, R.D. (2003). The Psychology of Spine Surgery.Washington, D.C.: American Psychological Association.