Source: https://openmedscience.com/medical-imaging-modalities/
Higher utilization of diagnostic imaging modalities and increased use of medications are associated with worse health outcomes in chronic whiplash-associated disorders.
Firstly, thank you to a great team of collaborators – Michael Westaway, Geoff Schneider and Dr Ben Andruski, who were instrumental with this publication. We were recently informed that this manuscript had been accepted for publication by Physiotherapy Canada. The abstract can be found here.
What Is the Problem?
When people attend a specialty clinic, like Vivo Cura Health for further evaluation of persistent pain following a motor vehicle collision, they come with a whole range of past experiences and future expectations. We commonly find that many of these people have had extensive work-ups in terms of imaging such as X-Rays, MRI and the like. Many well-meaning health care providers have also provided different medications in an effort to assist the person’s recovery. But, are these helpful or a hindrance in their recovery? And are they tied to clinical characteristics – i.e. is treatment matching the person’s personalized clinical requirements?
What Did We Do to Investigate This Further?
We asked all people attending to complete a series of questionnaires to evaluate their current pain and functional status – both for their physical and mental health. Then we used data from the attendee’s health record for diagnostic imaging and medication intake and linked it to the person’s current health status. We were also interested in knowing if their health status differed based on specific presenting clinical manifestations (pain classification category [nociceptive, nociplastic, or neuropathic], psychologic features, pain cognitions, and sleep) to get an overview of the effect of diagnostic imaging and medications on health outcomes in chronic whiplash-associated disorders (WAD).
What Did We Find?
We were able to access 270 people for the study who were over 17 years old and had not sustained a concussion.
Firstly, for medications – no class of medication was associated with better health outcomes! That probably makes sense, as if it did, the person wasn’t likely attending a specialty clinic for further assistance. Anti-inflammatories, anti-convulsants and the use of multiple medications were associated with worse pain and disability. More striking, was that after a collaborative assessment between the physician and physiotherapist, and evaluating the type of pain classification (tissue based, nerve based, widespread) the PWLE was describing, that medications were not matched to the pain classification type. This is disappointing as guidelines are available for nerve-related pain, and widespread pain – whilst certain medication classes are generally not thought to be helpful for treating local, regional pain that is chronic – especially opioids, but that is what we found. Thankfully, topical medications were being used for widespread pain, which seems appropriate. Similarly, people with specific psychological manifestations – such as depression for example did not have medications directed towards their symptom profile. Use of anti-convulsants and multiple medications was associated with worse psychological and sleep symptoms – although given the nature of the study – the contrary may have also applied.
As far as utilization of diagnostic imaging modalities was concerned, receiving computed tomography, ultrasound or magnetic resonance imaging scans and multiple DI utilization were associated with worse health outcomes. In fact, higher levels of pain was associated with increased use of MRIs. I think we all know that MRIs can’t show pain – only age-related structure. This was disappointing. Similarly, all psychological manifestations were associated with increased utilization of diagnostic imaging, suggesting that health care providers are reaching out to imaging modalities for complex PWLE with complex needs.
Thus, worse physical and psychological health outcomes were present with increased medication and diagnostic imaging utilization.
In Conclusion:
It was disappointing to find, but not unexpected that medication intake and DI were not matched to clinical manifestations – hence why people were attending a specialist musculoskeletal pain clinic for further evaluation and management. This suggests that further education of health care providers is warranted to assist with appropriate health care resource utilization. And guidelines for appropriate management of chronic WAD is urgently required – although the Aussies may have solved that problem!!!
Reference:
Smith A, Westaway M, Schneider G, Andruski B. Association Between Diagnostic Imaging, Medication Intake, and Health Outcomes in Chronic Whiplash-Associated Disorders: An Observational Study. https://utppublishing.com/doi/epdf/10.3138/ptc-2024-0032 (Date of Publication: 4 November, 2024)
