THE EFFECT OF SOFT CERVICAL COLLARS ON PERSISTENT NECK PAIN IN PATIENTS WITH WHIPLASH INJURY

Objective: To assess the efficacy of soft cervical collars in the earl y management of whiplash-injury-related pain. Methods: A controlled, c linical trial was conducted in an urban ED. Adults with neck pain foll owing automobile crashes indicated their initial degrees of pain on a visual analog scale. Patients with cervical spine fractures or subluxa tion, focal neurologic deficits, or other major distracting injuries w ere excluded. Patients were assigned to receive a soft cervical collar or no collar based on their medical record numbers. Pain at greater t han or equal to 6 weeks postinjury was coded as none, better, same, or worse, and analyzed as 3 dichotomous outcomes: recovered (pain = none ); improved (pain = none or better); and deteriorated (pain = worse). Results: Of 250 patients enrolled, 196 (78%) were available for follow -up. Of these patients, 104 (53%) were assigned to the soft cervical c ollar group, and 92 (47%) to the control group. These groups were simi lar in age, gender, seat position in the car, seat belt use, and initi al pain score. Pain persisted at greater than or equal to 6 weeks in 1 22 (62%) patients. The groups showed no difference in follow-up pain c ategory (p = 0.59). There was no significant difference between the 2 groups in complete recovery (p = 0.34), improvement (p = 0.34), or det erioration (p = 0.60). The study had a power of 80% to detect an absol ute difference of at least 20% in recovery, 17% in improvement, and 7% in deterioration (2-tailed, alpha = 0.05). Conclusions: Most patients with whiplash injuries have persistent pain for at least 6 weeks. Sof t cervical collars do not influence the duration or degree of persiste nt pain.