How should I approach the management of chronic pain in patients with a history of whiplash injury?

Management of chronic pain in patients with a history of whiplash injury should begin with a comprehensive, person-centred assessment to identify factors contributing to the pain and its impact on the patient's life, consistent with NICE guidance on chronic pain management ². This assessment should include exploring the nature of the pain, its duration (persisting beyond 3 months), and any associated psychological or functional impairments, fostering a collaborative relationship with the patient to support shared decision-making ².

Given that whiplash injury can lead to chronic secondary pain due to identifiable tissue injury or chronic primary pain when pain persists disproportionately to the injury, clinicians should consider both possibilities and re-evaluate the diagnosis over time ².

Initial management should emphasise non-pharmacological approaches such as education about pain, encouragement of self-management strategies, and physical rehabilitation tailored to the individual, including graded exercise and physiotherapy, which are supported by musculoskeletal pain literature as effective in neck pain and whiplash-associated disorders (Jensen and Harms-Ringdahl, 2007) ².

Pharmacological treatment should be cautious and personalised, avoiding long-term use of opioids or dependence-forming medicines unless clearly indicated, and regularly reviewing medication effectiveness and side effects ². NICE recommends reviewing and optimising medicines to minimise harm and support adherence ².

Psychological support or referral to multidisciplinary pain management programmes that combine physical and psychological components may be beneficial, especially when pain causes significant distress or disability ².

In acute or subacute phases post-whiplash, pain control may involve analgesics, but in chronic stages, the focus shifts to functional restoration and coping strategies rather than solely on pain elimination ¹,².

Finally, ongoing monitoring and re-assessment are essential, as chronic pain presentations can evolve, and management plans should be adapted accordingly ².