Medication

Injury type: Acute/ Chronic

Category: Medical Options

Rating: Promising

What is it?

A medication, alternatively a medicine or a drug, is a substance or a combination of substances administered to a human being to cure/prevent a disease or alternatively manage symptoms of a disease/injury. For people with whiplash, common medications prescribed include pain-relieving medications called analgesics and anti-inflammatory medications to control local inflammation.

How does it work?

Analgesics and anti-inflammatory medications are thought to act at the central nervous system (Brain and Spinal Cord) and peripheral nervous system (any nerves beyond Brain and Spinal Cord). Some of the anti-inflammatory medications (such as Aspirin) stop the production of certain enzymes which in turn decrease the production of substances involved in pain and inflammation.

Is it effective?

A clinical commentary¹ summarising evidence associated with pharmacological treatment for whiplash highlighted weak evidence base to support the use of medications. Similarly, a review of systematic reviews² on non-steroidal anti-inflammatory drugs (NSAIDs) showed that while oral NSAIDs may be more effective than placebo for neck pain and associated disorders, evidence on the use of NSAIDs for whiplash is lacking. Despite the weak and limited evidence base, the use of simple analgesics (e.g. paracetamol) and NSAIDs is commonly recommended for the initial management of whiplash. This evidence originates from two reviews^3,4 synthesising evidence from highest level of primary studies, systematic reviews, and existing clinical practice guidelines.

In addition to analgesics and NSAIDs, the use of other medications such as opioids, muscle relaxants, antidepressants and anticonvulsants have also been investigated in the literature. The clinical commentary¹ highlighted a lack of evidence especially from randomised controlled trials on these medications for whiplash. However, there is some evidence^1,3 to suggest that these medications may be considered on individual basis if the symptoms are severe and sustained or unresponsive to simple analgesics or NSAIDs.

Are there any disadvantages?

Some of these medications, especially ant-inflammatory medications, may have side effects. These include nausea, vomiting, stomach pain, heart burn, gastritis, abdominal burning, gastrointestinal bleeding, liver toxicity, stomach ulcers and bleeding, ringing in the ears, rash, kidney problems and dizziness or light-headedness. Some of these pain relieving medications can be addictive if taken regularly.

Where do you get it?

Some of these medications are available as over-the-counter medications in supermarkets and pharmacies without a prescription. Others, especially those with higher dosages, require a prescription from a medical doctor.

Recommendations

The evidence to support these medications is limited and unclear. While it seems that pain relieving medication and anti-inflammatory medications may help in symptom management, especially in the short term after whiplash, more research is warranted before an unequivocal recommendation can be made. Usage of medications, especially in combination or higher dosages, should be monitored regularly by a qualified and registered health professional such as medical doctor and/or a pharmacist.