You’re stopped at a red light in your beautiful black Pontiac G5, on a gorgeous sunny day in June. Sun roof is open, Ed Sheeran’s on the radio, ice cold cola in the cup holder. Then suddenly, without warning, someone bumps their car into your rear end. A 5 km/h nudge, but it gave you a good shake nonetheless, cars are big and heavy after all. You look up at the light, still red. Son of a bee sting, this donkey rear ended you while you were stopped at a red light. You get out of the car, mutter every curse word you know under your breath, and exchange information. Not enough damage for a police report, no apparent need for an ambulance ride, but annoying as can be.
That evening you start to get some neck pain and you spend most of the evening stewing about the accident. Great. Now you’re gonna have to go the autobody shop AND the doctor cuz your neck hurts and you sure as hell aren’t gonna pay for physio yourself. Better mention that to the insurance adjustor. You’re a victim, you shouldn’t have to deal with this garbage. You crush a bag of chips and go to bed, or try to, but you have a horrible sleep because of that neck pain.
The next morning your pain has worsened. It is so horrible, that you decide you need to spend some time in the emergency room. Your back hurts now too- this is not good, you gotta go to work. Those pizza pops in the fridge are NOT free and neither is your HBO subscription, and if you don’t work you don’t get paid. So into emerg you go, where they do x-rays after they hear you’ve been in a car accident. No fractures. Phew. They recommend follow up with family doc and physiotherapy for your “myofascial pain.”
This is the turning point for most people. At this point, 90-95% of people get better. Their pain gradually reduces, they continue with their lives, they get good advice from their physicians and physiotherapists, and they return to their full function, with a fully functional Pontiac G5.
What about the other 5-10%? Don’t they get back to loving Ed Sheeran on a sunny day in June?
The unfortunate truth is that the other 5-10% trend in the wrong direction and their pain persists. The reasons and prognostic indicators for this are varied and extensive, but the fact of the matter is that a number of these individuals who have been in motor vehicle accidents will go on to experience chronic pain. These people have high levels of pain, decreased levels of function, and many times deteriorating mental health following an accident- even one with very low force like the one described above. These people have pain for months and years following the accident- and often it will never go away. Here are some quotes from some of my patients with chronic pain:
“I used to run marathons, and now I struggle to walk up stairs.”
“I lost my job as a laborer because I could no longer keep up, then my wife left me.”
“It’s like someone constantly has a fiery dagger stabbed into my back, and occasionally that someone will decide to twist it.”
“I just want my life back.”
These quotes are not included to create pity, but rather to create awareness. Cancer patients I have worked with have had similar quotes, yet these unfortunate chronic painers often deal with people telling them they are faking. They are often thought of as “seeking a settlement,” or “craving attention,” which as you can imagine is great for their mental health. Even misinformed medical professionals will often not find a mechanical cause for a patient’s pain and label them as fakers. The fact of the matter is chronic pain syndrome is a legitimate condition that can greatly change an individual’s life.
I work in a unique context where I will often see these patients 2+ yrs after their 5km/h accident and many have similar stories. They bounce between health care professionals, searching for a reason and a cure for their pain- and often they will get conflicting answers. They get a ton of diagnostic imaging that comes back relatively normal. They are on high dose pain killers and have been for an extended period of time. Often they have experienced a rapid decline in their mental health, and are now on medication for that as well. The vast majority have stopped moving- that is to say, no sports, no hobbies, no stairs.
As a physiotherapist, when these patients come see me in clinic they are not experiencing pain because of a sprain or strain- the damaged tissues are long past their healing times. No soft tissue work or mobilization is going to change anything. What I do change, however, is their understanding of their pain and their function. I combat the deconditioning, and teach them that it is safe to move. From there, they improve.
Does chronic pain syndrome ever go away? Most practitioners consider it a permanent condition- the pain will always persist but function can be improved. I have experienced a few chronic pain syndrome patients that have improved so dramatically that they are functioning as they were before the accident- but they still have their pain.
So take home message: chronic pain syndrome is a real thing and we need to be aware of it. There are fakers out there, there always will be, but those are a very small portion of the population.
Thanks for reading! As always I welcome feedback and comments.
Matt Goertzen's Blog 