Meds for WADs: The latest evidence

As a general rule, PTs do not interfere with their patients’ medications even if they report no benefit from them. However we should still have some basic knowledge of the current evidence regarding certain pharmaceutical interventions.

I think you will agree that patients with chronic whiplash-associated disorders (WAD) rarely report of any significant benefit from their meds and report that they take them simply because their doctor told them so.

This 2016 review paper concluded that the use of NSAIDs in the acute phase of injury may be of some value; however their use in chronic WADs was questionable especially considering the potential risks of GI and renal adverse effects with their prolonged use.

There is some evidence to support the use of antidepressants in those with WAD only if they have concurrent depression or a sleep disorder associated with their pain.

Anticonvulsants are another option but should only be considered if all other treatments fail.

Opioids (hydrocodone, methadone, fentanyl, and codeine) may temporarily reduce pain in the short-term but they are to be avoided due to the lack of evidence for their long-term benefits and the serious risks associated with them.

Several high-quality studies support the efficacy of radiofrequency neurotomy for the treatment of facet joint pain in WADs. Therefore a nerve block is not a bad thing if everything else fails.

Reference: Curatolo M. Pharmacological and Interventional Management of Pain After Whiplash Injury. J Orthop Sports Phys Ther. 2016 Oct;46(10):845-850.