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Neck pain and whiplash

Persistent neck pain commonly arises from the facet joints, particularly after a whiplash injury. Diagnostic blocks can establish whether these joints are responsible, and radiofrequency treatment can provide lasting relief for some people. Assessment also covers nerve, disc and muscular contributors, and neck-related headache.

Most neck pain after an injury settles over weeks. In a significant minority it does not, and long after the scans have been reported as normal the pain remains real and limiting. Persistent neck pain — particularly after a whiplash-type injury — is one of the better understood problems in pain medicine, because its most common source can be tested directly.

Why does whiplash cause lasting pain? In a rapid acceleration–deceleration injury, the small facet joints of the neck can be strained in ways that do not show on X-ray or MRI. Research in people with persistent pain after whiplash has repeatedly found the facet joints to be the most common source, identifiable in a substantial proportion of cases when properly tested with diagnostic blocks. A normal scan therefore does not mean nothing is wrong; it means the responsible structure is not one a scan shows well.

How is the source identified? The pattern of pain gives the first clues — facet pain is typically one-sided or both-sided neck and shoulder-blade region pain, worse with turning or extending the neck. The definitive test is a medial branch block: numbing the small nerves that supply the suspected joint under X-ray guidance and observing whether the pain drops during the anaesthetic window. Performed twice for reliability, this establishes the diagnosis with reasonable confidence.

What treatment is available? Radiofrequency neurotomy — interrupting the nerves that carry pain from the joint, using thermal, pulsed (low-temperature) or cryoablation techniques as appropriate. In well-selected patients relief typically lasts six to twelve months and the procedure can be repeated when the effect wears off as nerves regenerate. The evidence for cervical radiofrequency in properly selected patients is among the stronger evidence in interventional pain medicine, though not everyone responds and selection is exactly what the diagnostic blocks are for.

What about headaches? Headache at the back of the head frequently originates from the upper cervical joints or the occipital nerves rather than from the head itself. Where the pattern suggests it, the same diagnostic logic applies — blocks of the upper cervical medial branches or occipital nerves — with radiofrequency treatment available where a source is confirmed. Migraine and other headache types are considered in the assessment, because more than one can be present.

What if the pain goes down my arm? Arm-dominant pain in a nerve's territory, with pins and needles or weakness, points to a nerve root problem — usually a disc protrusion or foraminal narrowing — and follows a different pathway: targeted nerve root injection for diagnosis and relief, and surgical referral where indicated.

Beyond procedures. Persistent neck pain responds to graded strengthening and movement retraining, and any procedure is planned alongside that work. Where the injury occurred in a motor vehicle accident, treatment can proceed within the relevant claims process; bring your claim details to the appointment.

Sources: International Association for the Study of Pain; Spine Intervention Society; Healthdirect Australia.