The effect of soft cervical collars on persistent neck pain in patients with whiplash injury.
OBJECTIVE
To assess the efficacy of soft cervical collars in the early management of whiplash-injury-related pain.


METHODS
A controlled, clinical trial was conducted in an urban ED. Adults with neck pain following automobile crashes indicated their initial degrees of pain on a visual analog scale. Patients with cervical spine fractures or subluxation, focal neurologic deficits, or other major distracting injuries were excluded. Patients were assigned to receive a soft cervical collar or no collar based on their medical record numbers. Pain at > or = 6 weeks postinjury was coded as none, better, same, or worse, and analyzed as 3 dichotomous outcomes: recovered (pain = none); improved (pain = none or better); and deteriorated (pain = worse).


RESULTS
Of 250 patients enrolled, 196 (78%) were available for follow-up. Of these patients, 104 (53%) were assigned to the soft cervical collar group, and 92 (47%) to the control group. These groups were similar in age, gender, seat position in the car, seat belt use, and initial pain score. Pain persisted at > or = 6 weeks in 122 (62%) patients. The groups showed no difference in follow-up pain category (p = 0.59). There was no significant difference between the 2 groups in complete recovery (p = 0.34), improvement (p = 0.34), or deterioration (p = 0.60). The study had a power of 80% to detect an absolute difference of at least 20% in recovery, 17% in improvement, and 7% in deterioration (2-tailed, alpha = 0.05).


CONCLUSIONS
Most patients with whiplash injuries have persistent pain for at least 6 weeks. Soft cervical collars do not influence the duration or degree of persistent pain.
Gennis
P
P
Bronx Municipal Hospital Center, Department of Emergency Medicine, NY 10461, USA. pskm34a@prodigy.com
Miller
L
L
Gallagher
E J
EJ
Giglio
J
J
Carter
W
W
Nathanson
N
N
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001915:Braces; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D019547:Neck Pain / Q000209:etiology*; D010147:Pain Measurement; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000534:rehabilitation*
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal