Preventing chronic pain after whiplash injury

Grant ID: EMPJ-379R27-2017

Project Summary

After whiplash injury, half of patients never fully recover. The human and economic cost is enormous, and current mainstay treatments are ineffective. Most recovery, if it occurs, takes place in the first two to three months. This early time period offers a ‘window of opportunity’ to pro-actively intervene and prevent the chronic pain. The Emergency Department (ED) is ideally placed to provide very early intervention. We have shown that upregulation of pain in the central nervous system occurs soon after whiplash injury and predicts poor recovery. We aim to target these central nervous system processes with pregabalin in conjunction with evidence based physiotherapy advice/exercise in the ED. The results have potential to fundamentally change the treatment of acute whiplash injury.

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Outcomes

The research team found there was large practice variation in management of neck soft tissue injury in the emergency department. More than half of the patients received CT scans with modest yield. Opioids were commonly used both in the emergency department and on discharge, with opioids appearing to be over-prescribed.

They concluded that further research into pregabalin prescription in the emergency department was warranted to reduce the over prescription of opioids. They also called for a standard management plan to be developed for patients presenting with acute neck soft tissue injury.

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Leveraged Funds

- Menzies Health Institute Queensland, Griffith University: $60,000
- In-kind: $60,600

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Dissemination

Nikles, J., Keijzers, G., Mitchell, G., Farrell, S.F., Perez, S., Schug, S., Ware, R.S., McLean, S.A., Connelly, L.B. and Sterling, M., 2021. Pregabalin versus placebo to prevent chronic pain after whiplash injury in at-risk individuals: results of a feasibility study for a large randomised controlled trial. Pain.

Nikles, J., Khan, S., Leou, J., Keijzers, G., Ng, J., Bond, C., Nakamura, G., Le, R. and Sterling, M., 2019. Retrospective descriptive observational study of patients who presented to an Australian hospital emergency department with neck soft tissue injury. Emergency Medicine Australasia, 31(5), pp.805-812.

Nikles, J., Keijzers, G., De Silva, M.I.D., Khan, S. and Sterling, M., 2019. Use of and attitudes to the role of medication for acute whiplash injury: A preliminary survey of emergency department doctors. Emergency Medicine Australasia, 31(3), pp.471-474.

Nikles, J., Keijzers, G., Mitchell, G., Schug, S., Ware, R., McLean, S.A., Connelly, L., Gibson, S., Farrell, S.F. and Sterling, M., 2018. Pregabalin versus placebo in targeting pro-nociceptive mechanisms to prevent chronic pain after whiplash injury in at-risk individuals–a feasibility study for a randomised controlled trial. Trials, 19(1), pp.1-11.

Conferences
-Sterling M., "Very early treatment of WAD in the Emergency Department – lessons learnt from a preliminary RCT", Whiplash 2019: NHMRC CRE in Road Traffic Injury Recovery Symposium, Brisbane, October 2019
-Nikles J, Khan S, Leou J, Keijzers G, Ng J, Bond C, Nakamura G, Le R, Sterling M., “Retrospective descriptive observational study of patients who presented to an Australian hospital emergency department with neck soft tissue injury”, Australian Pain Society Meeting 2019, Gold Coast, April 2019 [Oral]
-Nikles J, Khan S, Leou J, Keijzers G, Ng J, Bond C, Nakamura G, Le R, Sterling M., “A retrospective descriptive study of patients who presented to an Australian hospital Emergency Department with neck soft tissue injury”, BrisPain Multidisciplinary Conference, Brisbane, Dec 2018. [Poster]
-Bond C, Khan S, Leou J, Nikles J, Keijzers G, Sterling M., “Characteristics of patients who present to the GCUH Emergency Department with traumatic neck pain including whiplash injury”, Gold Coast Health Research Week Conference, Gold Coast, 2017. [Poster]

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