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  • Writer's pictureDr Josh Bonine DC

Whiplash and Nagging Pain

Whiplash Injury, the Central Nervous System

and Persistent Pain

There are many cases in which an injury is a result of a traumatic event causing persistent chronic pain. Logical reasoning would dictate that once a tissue is injured, the wound repair process is complete and the injured person returns to normal. In the cases when the pain becomes systemic (ex: a neck and shoulder injury results in chronic pain throughout the head, neck, bilateral shoulders and middle back), it is a common occurrence that these victims are cast as malingerers (patients who are exaggerating or faking their pain).

Research has shown that peripheral injuries, those occurring outside of the central nervous system, can cause increased “sensitization” of the central nervous system resulting in chronic, significant and permanent pain syndromes with persistent loss of function. Since this is about increased “sensitivity” to daily sensory input, traditional testing such as CT, MRI or EMG/NCV would be of little help.

One of the first examinations of published evidence of central "hypersensitivity" (HYPER = excess / too much / increased, SENSITIVITY = easily aware or hurt or excessive stimulation) after whiplash injury was done by Curatolo, Arendt-Nielsen, and Petersen-Felix (2004). They stated, “Tissue damage, detected or not by the available diagnostic methods, is probably the main determinant of central hypersensitivity...Central hypersensitivity may explain exaggerated pain in the presence of minimal nociceptive [painful stimuli] input arising from minimally damaged tissues” (Curatolo et al., 2004, p. 469).

“There is clear evidence that tissue trauma leads to a reversible increase in the excitability of the central nervous system. Potentially irreversible changes have been documented. These alterations may be responsible, at least in part, for persisting pain after injury” (Curatolo et al., 2004, p. 470). This has significant implications and is an important aspect of explaining what is happening to injury victims that continue to experience chronic pain and why early diagnosis is CRITICAL.

“This could account for pain and disability in the absence of objective signs of tissue damage in patients with whiplash.” (Curatolo et al., 2004, p. 469). Working with doctors that TRULY understand these mechanisms is important and is the only way to properly document these persistent pain syndromes in trauma victims. If you are a patient or attorney, this is important to know, because not all chiropractors, physical therapists, and doctors are created or educated the same.


Spine & Injury Centers of San Antonio is a local network of 5 chiropractic offices. As a group, we are raising the standard of care for injured patients and their families.

If you have recently been in a car accident, or had a personal injury, sports injury, or exercise injury, and are experiencing back pain, neck pain, knee pain, whiplash, headaches, leg pain, etc, our San Antonio injury chiropractors can help!

Our goal is to get you back to living a pain-free life as quickly as possible.

Click here to find a San Antonio chiropractor near me.


Curatolo, M., Arendt-Nielsen, L., & Petersen-Felix, S. (2004). Evidence, mechanisms, and clinical implications of central hypersensitivity in chronic pain after whiplash. The Clinical Journal of Pain, 20(6), 469-476.


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