Whiplash: "Why pay for what does not work?"

Objectives: To ascertain the relative and comparable efficacy of various therapies that are promoted for the resolution of whiplash associated disorder. Methods: To review the evidence based scientific literature, including meta-analyses, and from their data to develop a score for each therapy as it compares to another. To discuss from this data the positive and negative support that the evidence provides for the use of these therapies. Results: A home exercise program is superior to ice or passive mobilization, which is slightly more superior to rest and analgesia. Short-term use of simple analgesics or non-steroidal anti-inflammatory agents might be useful while patients undergo natural recovery. There is no evidence for the use of major tranquilizers or tricyclic antidepressants. Traction, electromagnetic therapy, collars, transcutaneous electrical nerve stimulations [TENS], ultrasound, neck school, spray and stretch, laser therapy, or traction, should not be used in the treatment of acute neck pain after whiplash. A water pillow might ease morning pain. Intra-articular injections of corticosteroid into the cervical zygapophyseal joints have not been shown to be efficacious nor cost-effective. Surgery is reserved for complicated cases with neurologic deficits or imaging evident disc herniation. Disc excision and fusion should only be conducted as part of an ethics approved research protocol. Radio-frequency neurotomy for cervical zygapophyseal joint pain, by skilled hands at a properly equipped facility, may provide relief of pain in selected and properly diagnosed patients. Conclusion: Many therapies are competing for health-agency dollars, some treatments are efficacious, some show no evidence, and some could be harmful.