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Posted July 18, 2002
Overall, this book gives the reader a 'been there, done that' feeling. All books are outdated by the time they are released, but this book even more so. In fact, some of the chapters are just reprints of publications from 1998, which in turn are pre-1998 in composition. There is no interesting thesis or theme that connects the chapters, and no suggestions of exactly why we face such a problem with whiplash. One can reproduce this book by doing a Medline search for review articles on whiplash. Put those articles together, and not only do you have a book, but one more up-to-date than this book, at a much lower cost. Additionally, there are 'fillers', those types of chapters you put in just to give the book some length, like cervical anatomy and physiology, and pseudoscientific pieces on chiropractic and alternative therapies, despite the fact that these therapies have not been tested in most cases, or not been found to be useful, in trials with whiplash subjects. There is much ado in this book about facet joints. If one carefully reviews the studies of facet joint injections and neurotomy in these patients, we find that very little science has been turned into a very great leap of faith. After utilising placebo-control and then comparative anaesthetic responses in a small, poorly defined group of subjects, Lord et al were able to screen patients to find 24 that had relief of pain with diagnostic blocks of the nerve supply to specific cervical facet joints. These 24 subjects were then randomised to receive either radiofrequency neurotomy of the nerve supply to the affected facet joint or a sham procedure (12 patients in each group). A total of 6 subjects in the control group and 3 in the treatment group failed to have benefit from the procedure. At 27 weeks, only one control subject had persistent relief of pain after the procedure, compared to 7 of 12 subjects in the active treatment arm. The problem is that 10 of the 12 control subjects were in litigation, compared to only 4 of the treatment group subjects. If litigation status has any substantial effect on response to therapy, this is a significant confounding variable, in a small study where confounders cannot be readily discounted. In a larger, though uncontrolled study, Sapir et al treated 46 subjects with radiofrequency neurotomy for so-called facet joint pain, and at 2 weeks after the procedure, the majority of subjects had a 50% reduction or more in neck pain. Of course, without a control group the level of true effectiveness of the procedure itself is difficult to interpret. And that is the extent of trials of radiofrequency neurotomy for neck pain. The lack of sufficient data limits the clinician's ability to recommend this invasive procedure. There is only one placebo-controlled trial to date, and that one had a major confounder in the control group. It does not seem appropriate for clinicians to receive this barrage of facet joint innuendo when there is so little in the way of clinical trials upon which to base clinical practice. After reading the chapter by Barnsley et al (a mere reprint of a 1998 article), one is recommended to read the following: Ferrari R. The many facets of whiplash. Spine 2001;26:2063-2064. Ferrari R. Radiofrequency neurotomy. Spine 2002;27:327-336. Finally, a number of the authors demonstrate a shared coping mechanism, they refer to whiplash study outcomes in Lithuania, but to the 1996 study rather than the prospective 1999 study. The reason for this may be that the material for this book was put together in late 1999, which would explain why it seems a very outdated book. Alternatively, it may be that the only way some can cope with the damaging effects of the 1999 Lithuanian study is by blocking it out of their consciousness, as we explain in: Kwan O, Friel J. A new strategy to support the 'chWas this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.