Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report

Hanna Edebol; Tommy Nordén; Torsten Norlander

doi:doi:10.11648/j.pbs.20130206.12

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Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report

Hanna Edebol, Tommy Nordén, Torsten Norlander

Published in Psychology and Behavioral Sciences (Volume 2, Issue 6)

Received: 2 December 2013 Accepted: Published: 20 December 2013

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Abstract

Pain is a major public health problem and the needs for more differentiated and flexible treatment options are obvious. The purpose of the present study was to examine, for the first time, experiences from long-term flotation Restricted Environmental Stimulation Technique (REST) made by a patient with chronic Whiplash Associated Disorder (WAD), grade IV. The patient of the present study was a middle aged native-born Caucasian male from Sweden who had been diagnosed with chronic WAD IV by a licensed physician. The patient performed regular flotation during one and a half year and wrote about his experiences in a diary. A semi-structured interview was conducted at the end of therapy. Both the diary and the interviews were analyzed with help of the empirical phenomenological psychological method and results describe experiences of relaxation, pain relief, sleep and deep rest, mental coping, increased energy, wellbeing and behavioral changes as a result of flotation. A model describes the rehabilitative circuit of chronic whiplash during flotation and is in line with the potential role of a stress response system for development and management of chronic whiplash. The study provides qualitative insights into the experiences of flotation as a pain- and stress- management system for chronic whiplash. Results are encouraging for future research and even suggest that interested clinics may use flotation-REST in order to relieve chronic pain and enhance the quality of life for a more comprehensive group of patients with whiplash associated disorders.

Published in	Psychology and Behavioral Sciences (Volume 2, Issue 6)
DOI	10.11648/j.pbs.20130206.12
Page(s)	206-216
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Chronic WAD, Whiplash, Stress, Pain, Flotation, Phenomenology

References

[1]	L. J. Carroll, L. W. Holm, S. Hogg-Johnson, P. Côté, J. D. Cassidy, S. Haldeman, M. Nordin, E. L. Hurwitz, E. J. Carragee, G. van der Velde, P. M. Peloso, and J. Guzman, "Course and prognostic factors for neck pain in Whiplash-Associated Disorders (WAD). Results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders," Eur. Spine. J., 2008, vol. 17, pp. 83-92.
[2]	J. M. Elliott, J. T. Noteboom, T. W. Flynn, and M Sterling, "Characterization of acute and chronic whiplash associated disorders," J. Orthop. Sports. Phys. Ther., 2009, vol. 39, pp. 312-323.
[3]	L. Bunketorp, L. Nordholm, and J. Carlsson, "A descriptive analysis of disorders in patients 17 years following motor vehicle accidents," Eur. Spine J., 2002, vol. 11, pp. 227-234.
[4]	M. Sterling, G. Jull, and J. Kenardy, "Physical and psychological factors maintain long-term predictive capacity post-whiplash injury," Pain 2006, vol.122, pp. 102-108.
[5]	L. Blincoe, A. Seay, and E. Zaloshnja, "The economic impact of motor vehicle crashes, 2000. Washington, DC", National Highway Traffic Safety Administration, 2002.
[6]	C. C. Joslin, S. N. Khan, and G. C. Bannister, "Long-term disability after neck injury: a comparative study," J. Bone Joint Surg. Br., 2004, vol. 86, pp. 1032-1034.
[7]	W. O. Spitzer, M. L. Skovron, L. R. Salmi, J. D. Cassidy, J. Duranceau, and E. Zeiss E, "Scientific monograph of the Quebec Task Force on whiplash-associated disorders: redefining "whiplash" and its management," Spine 1995, vol.15, pp. 1-73.
[8]	M. Allen, S. Barron, M. Broudo, S. Lubin, and H. Anton, "British Columbia whiplash initiative - a comprehensive syllabus," Vancouver, B. C., Physical Medicine Research Foundation; 1997.
[9]	M. Simpson, R. Buckman, M. Stewart, P. Maguire, M. Lipkin, D. Novack, and J. Till, "Doctor-patient communication: the Toronto consensus statement," B. M. J., 1991, vol. 303, pp. 1385-1387.
[10]	A. K. Burton, and G. Waddell, "Educational and informational approaches. In New avenues for the prevention of chronic musculoskeletal pain and disability," Edited by S. J. Linton, Oxford: Elsevier; 2002, pp. 53-76.
[11]	T. McClune, A. K. Burton, and G. Waddell, "Whiplash associated disorders: a review of the literature to guide patient information and advice," Emerg. Med. J., 2002, vol.19, pp. 499-506.
[12]	A. Seferiadis, M. Rosenfeld, and R. Gunnarsson, "A review of treatment interventions in whiplash-associated disorders," Eur. Spine. J., 2004, vol. 13, pp. 387-397.
[13]	M. Rosenfeld, A. Seferiadis, J. Carlsson, and R. Gunnarsson, "Active intervention in patients with whiplash-associated disorders improves long-term prognosis - a randomized controlled clinical trial," Spine, 2003, vol. 28, pp. 2491-2498.
[14]	G. G. M. Scholten-Peeters, A. P. Verhagen, G. Bekkering , D. A. W. M. van der Windt, L. Barnsley, R. A. B. Oostendorp, and E. J. M. Hendriks, "Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies," Pain, 2003, vol. 104, pp. 303-322.
[15]	L. Bunketorp-Kall, "Psychological determinants of quality of life in patients with whiplash associated disorders- a prospective study," Disability Rehab., 2009, vol. 31, pp. 227-236.
[16]	J. Nijs, J. van Oosterwijck, and W. de Hertogh, "Rehabilitation of chronic whiplash: treatment of cervical dysfunctions or chronic pain syndrome?," Clin. Rheumatol., 2009, vol. 28, pp. 243-251.
[17]	D. van Dierendonck and J. te Nijenhuis, "Flotation restricted environmental stimulation therapy (REST) as a stress-management tool: A meta-analysis," Psychol. Health, 2005, vol. 20, pp. 405-412.
[18]	S. Å. Bood, A. Kjellgren, and T. Norlander, "Treating stress related pain with flotation-REST: Are there differences between women and men?," Pain Res. Manag., 2009, vol. 14, pp. 293-298.
[19]	S. Å. Bood, U. Sundequist, A. Kjellgren, T. Norlander, L. Nordström, K. Nordenström, and G. Nordström, "Eliciting the relaxation response with the help of flotation–REST (Restricted Environmental Stimulation Technique) in patients with stress-related ailments," Int. J. Stress. Manag., 2006, vol. 13, pp. 154-175.
[20]	T. Norlander, H. Bergman, and T. Archer, "Primary process in competitive archery performance: Effects of flotation REST," J. Appl. Sport. Psychol., 1999, vol. 11, pp. 194-209.
[21]	A. Kjellgren, U. Sundequist, T. Norlander, and T. Archer, "Effects of flotation-REST on muscle tension pain," Pain Res. Manag., 2001, vol. 6, pp. 181-189.
[22]	S. Å. Bood, U. Sundequist, A. Kjellgren, G. Nordström, and T. Norlander, "Effects of flotation-REST (Restricted Environmental Stimulation Technique) on stress related muscle pain: What makes the difference in therapy, attention-placebo, or the relaxation response?," Pain Res. Manag., 2005, vol. 10, pp. 201-209.
[23]	S. Å. Bood, U. Sundequist, A. Kjellgren, G. Nordström, and T. Norlander, "Effects of flotation-REST (Restricted Environmental Stimulation Technique) on stress related muscle pain: Are 33 flotation sessions more effective as compared to 12 sessions?," Soc. Behav. Person., 2007, vol. 35, pp. 143-156.
[24]	H. Edebol, A. Kjellgren, S. Å. Bood, and T. Norlander, "Enhanced independence and quality of life through treatment with flotation-Restricted Environmental Stimulation Technique of a patient with both Attention Deficit Hyperactivity Disorder and Aspergers Syndrome: a case report," Cases J., 2009, vol. 2, pp. 69-79.
[25]	H. Edebol, S. Å. Bood, and T. Norlander, "Chronic whiplash-associated disorders and their treatment using flotation-REST (Restricted Environmental Stimulation Technique)," Qual. Health Res., 2008, vol. 18, pp. 480-488.
[26]	T. Norlander, H. Bergman, and T. Archer, "Effects of flotation REST on creative problem solving and originality," J. Environ. Psychol., 1998, vol. 18, pp. 399-408.
[27]	T. Norlander, A. Kjellgren, and T. Archer, "The experience of flotation-REST as a function of setting and previous experience of altered states of consciousness," Imagin. Cogn. Person., 2001, vol. 20, pp. 161-178.
[28]	T. Norlander, A. Kjellgren, and T. Archer, "Effects of flotation versus chamber- restricted environmental stimulation technique (REST) on creativity and realism under stress and non-stress conditions," Imagin. Cogn. Person., 2003, vol. 22, pp. 341-357.
[29]	S.A McLean, D. J. Clauw, J. L. Abelson, and I. Liberzon, "The development of persistent pain and psychological morbidity after motor vehicle collision: integrating the potential role of stress response systems into a biopsychosocial model," Psychosom. Med., 2005, vol. 67, pp. 783-790.
[30]	B-M. Stalnacke, "Relationship between symptoms and psychological factors five years after whiplash injury," J. Rehabil. Med., 2009, vol. 41, pp. 353-9.
[31]	World Medical Association Declaration of Helsinki, 2008: Available at [http://www.wma.net/en/30publications/10policies/b3/17c.pdf, Accessed August 26, 2013]
[32]	G. Karlsson, "Psychological qualitative research from a phenomenological perspective," Göteborg, Sweden: Almqvist & Wiksell International; 2005.
[33]	M. Niklasson, I. Niklasson, and T. Norlander, "Sensorimotor therapy: Physical and psychological regressions contribute to an improved kinesthetic and vestibular capacity in children and adolescents with motor difficulties and concentration problems," Soc. Behav. Person., 2010, vol. 38, pp. 327-346.
[34]	T. Nordén, A. Eriksson, A. Kjellgren, and T. Norlander, "Involving clients and their relatives and friends in the psychiatric care: Case managers´ experiences of training in resource group assertive community treatment," PsyCH J., 2012, vol. 1, pp. 15-27.
[35]	M. Rosenfeld, R. Gunnarsson, and P, Borenstein, "Early intervention in whiplash-associated disorders: a comparison of two treatment protocols," Spine, 2000, vol. 25, pp. 1782-1787.
[36]	A. D. Bonk, R. Ferrari, G. D. Giebel, M. Edelmann, and R. Huser, "Prospective, randomized, controlled study of activity versus collar, and the natural history of whiplash injury, in Germany," J. Muscul. Pain, 2000, vol. 8, pp. 123-132.
[37]	G. E. Borchgrevink, A. Kaasa, D. McDonagh, T. Stiles, O. Haraldseth, and I. Lere I, "Acute treatment of whiplash neck strain injuries: a randomized trial of treatment during the first 14 days after a car accident", Spine, 1998, vol. 23, pp. 25-31.
[38]	A. Soderlund, C. Olerud, and P. Lindberg, "Acute whiplash-associated disorders (WAD): the effects of early mobilization and prognostic factors in long-term symptomatology," Clin. Rehab., 2000, vol. 14, pp. 457-467.
[39]	B. Banic, S. Petersen-Felix, O. K. Andersen, B. P. Radanov; P. M. Villiger, L. Arendt-Nielsen, and M. Curatolo, "Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia," Pain, 2004, vol. 107, pp: 7-15.
[40]	K. Åsenlöf, S. Olsson, S. Å. Bood, and T. Norlander, "Case studies on fibromyalgia and burn-out depression using psychotherapy in combination with flotation-REST: Personality development and increased well-being," Imagin. Cogn. Person., 2007, vol. 26, pp. 259-271.
[41]	H. Kasch, E. Qerama, F.W. Bach, and T. S. Jensen, "Reduced cold pressure pain tolerance in non-recovered whiplash patients: a 1-year prospective study," Eur. J. Pain, 2005, vol. 9, pp. 561-569.

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APA Style

Hanna Edebol, Tommy Nordén, Torsten Norlander. (2013). Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report. Psychology and Behavioral Sciences, 2(6), 206-216. https://doi.org/10.11648/j.pbs.20130206.12

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ACS Style

Hanna Edebol; Tommy Nordén; Torsten Norlander. Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report. Psychol. Behav. Sci. 2013, 2(6), 206-216. doi: 10.11648/j.pbs.20130206.12

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AMA Style

Hanna Edebol, Tommy Nordén, Torsten Norlander. Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report. Psychol Behav Sci. 2013;2(6):206-216. doi: 10.11648/j.pbs.20130206.12

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@article{10.11648/j.pbs.20130206.12,
  author = {Hanna Edebol and Tommy Nordén and Torsten Norlander},
  title = {Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report},
  journal = {Psychology and Behavioral Sciences},
  volume = {2},
  number = {6},
  pages = {206-216},
  doi = {10.11648/j.pbs.20130206.12},
  url = {https://doi.org/10.11648/j.pbs.20130206.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.pbs.20130206.12},
  abstract = {Pain is a major public health problem and the needs for more differentiated and flexible treatment options are obvious. The purpose of the present study was to examine, for the first time, experiences from long-term flotation Restricted Environmental Stimulation Technique (REST) made by a patient with chronic Whiplash Associated Disorder (WAD), grade IV. The patient of the present study was a middle aged native-born Caucasian male from Sweden who had been diagnosed with chronic WAD IV by a licensed physician. The patient performed regular flotation during one and a half year and wrote about his experiences in a diary. A semi-structured interview was conducted at the end of therapy. Both the diary and the interviews were analyzed with help of the empirical phenomenological psychological method and results describe experiences of relaxation, pain relief, sleep and deep rest, mental coping, increased energy, wellbeing and behavioral changes as a result of flotation. A model describes the rehabilitative circuit of chronic whiplash during flotation and is in line with the potential role of a stress response system for development and management of chronic whiplash. The study provides qualitative insights into the experiences of flotation as a pain- and stress- management system for chronic whiplash. Results are encouraging for future research and even suggest that interested clinics may use flotation-REST in order to relieve chronic pain and enhance the quality of life for a more comprehensive group of patients with whiplash associated disorders.},
 year = {2013}
}

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TY  - JOUR
T1  - Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report
AU  - Hanna Edebol
AU  - Tommy Nordén
AU  - Torsten Norlander
Y1  - 2013/12/20
PY  - 2013
N1  - https://doi.org/10.11648/j.pbs.20130206.12
DO  - 10.11648/j.pbs.20130206.12
T2  - Psychology and Behavioral Sciences
JF  - Psychology and Behavioral Sciences
JO  - Psychology and Behavioral Sciences
SP  - 206
EP  - 216
PB  - Science Publishing Group
SN  - 2328-7845
UR  - https://doi.org/10.11648/j.pbs.20130206.12
AB  - Pain is a major public health problem and the needs for more differentiated and flexible treatment options are obvious. The purpose of the present study was to examine, for the first time, experiences from long-term flotation Restricted Environmental Stimulation Technique (REST) made by a patient with chronic Whiplash Associated Disorder (WAD), grade IV. The patient of the present study was a middle aged native-born Caucasian male from Sweden who had been diagnosed with chronic WAD IV by a licensed physician. The patient performed regular flotation during one and a half year and wrote about his experiences in a diary. A semi-structured interview was conducted at the end of therapy. Both the diary and the interviews were analyzed with help of the empirical phenomenological psychological method and results describe experiences of relaxation, pain relief, sleep and deep rest, mental coping, increased energy, wellbeing and behavioral changes as a result of flotation. A model describes the rehabilitative circuit of chronic whiplash during flotation and is in line with the potential role of a stress response system for development and management of chronic whiplash. The study provides qualitative insights into the experiences of flotation as a pain- and stress- management system for chronic whiplash. Results are encouraging for future research and even suggest that interested clinics may use flotation-REST in order to relieve chronic pain and enhance the quality of life for a more comprehensive group of patients with whiplash associated disorders.
VL  - 2
IS  - 6
ER  -

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Author Information

Hanna Edebol

?rebro University, Nutrition Gut Brain Interactions Research Centre, SE-701 82 ?rebro, Sweden
Tommy Nordén

Evidens University College, Packhusplatsen 2, SE-411 13 G?teborg, Sweden
Torsten Norlander

Evidens University College, Packhusplatsen 2, SE-411 13 G?teborg, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Nobels v?g 9, SE-171 65 Solna, Sweden

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APA Style

Hanna Edebol, Tommy Nordén, Torsten Norlander. (2013). Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report. Psychology and Behavioral Sciences, 2(6), 206-216. https://doi.org/10.11648/j.pbs.20130206.12

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ACS Style

Hanna Edebol; Tommy Nordén; Torsten Norlander. Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report. Psychol. Behav. Sci. 2013, 2(6), 206-216. doi: 10.11648/j.pbs.20130206.12

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AMA Style

Hanna Edebol, Tommy Nordén, Torsten Norlander. Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report. Psychol Behav Sci. 2013;2(6):206-216. doi: 10.11648/j.pbs.20130206.12

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@article{10.11648/j.pbs.20130206.12,
  author = {Hanna Edebol and Tommy Nordén and Torsten Norlander},
  title = {Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report},
  journal = {Psychology and Behavioral Sciences},
  volume = {2},
  number = {6},
  pages = {206-216},
  doi = {10.11648/j.pbs.20130206.12},
  url = {https://doi.org/10.11648/j.pbs.20130206.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.pbs.20130206.12},
  abstract = {Pain is a major public health problem and the needs for more differentiated and flexible treatment options are obvious. The purpose of the present study was to examine, for the first time, experiences from long-term flotation Restricted Environmental Stimulation Technique (REST) made by a patient with chronic Whiplash Associated Disorder (WAD), grade IV. The patient of the present study was a middle aged native-born Caucasian male from Sweden who had been diagnosed with chronic WAD IV by a licensed physician. The patient performed regular flotation during one and a half year and wrote about his experiences in a diary. A semi-structured interview was conducted at the end of therapy. Both the diary and the interviews were analyzed with help of the empirical phenomenological psychological method and results describe experiences of relaxation, pain relief, sleep and deep rest, mental coping, increased energy, wellbeing and behavioral changes as a result of flotation. A model describes the rehabilitative circuit of chronic whiplash during flotation and is in line with the potential role of a stress response system for development and management of chronic whiplash. The study provides qualitative insights into the experiences of flotation as a pain- and stress- management system for chronic whiplash. Results are encouraging for future research and even suggest that interested clinics may use flotation-REST in order to relieve chronic pain and enhance the quality of life for a more comprehensive group of patients with whiplash associated disorders.},
 year = {2013}
}

Copy | Download

TY  - JOUR
T1  - Behavior Change and Pain Relief in Chronic Whiplash Associated Disorder Grade IV Using Flotation Restricted Environmental Stimulation Technique: A Case Report
AU  - Hanna Edebol
AU  - Tommy Nordén
AU  - Torsten Norlander
Y1  - 2013/12/20
PY  - 2013
N1  - https://doi.org/10.11648/j.pbs.20130206.12
DO  - 10.11648/j.pbs.20130206.12
T2  - Psychology and Behavioral Sciences
JF  - Psychology and Behavioral Sciences
JO  - Psychology and Behavioral Sciences
SP  - 206
EP  - 216
PB  - Science Publishing Group
SN  - 2328-7845
UR  - https://doi.org/10.11648/j.pbs.20130206.12
AB  - Pain is a major public health problem and the needs for more differentiated and flexible treatment options are obvious. The purpose of the present study was to examine, for the first time, experiences from long-term flotation Restricted Environmental Stimulation Technique (REST) made by a patient with chronic Whiplash Associated Disorder (WAD), grade IV. The patient of the present study was a middle aged native-born Caucasian male from Sweden who had been diagnosed with chronic WAD IV by a licensed physician. The patient performed regular flotation during one and a half year and wrote about his experiences in a diary. A semi-structured interview was conducted at the end of therapy. Both the diary and the interviews were analyzed with help of the empirical phenomenological psychological method and results describe experiences of relaxation, pain relief, sleep and deep rest, mental coping, increased energy, wellbeing and behavioral changes as a result of flotation. A model describes the rehabilitative circuit of chronic whiplash during flotation and is in line with the potential role of a stress response system for development and management of chronic whiplash. The study provides qualitative insights into the experiences of flotation as a pain- and stress- management system for chronic whiplash. Results are encouraging for future research and even suggest that interested clinics may use flotation-REST in order to relieve chronic pain and enhance the quality of life for a more comprehensive group of patients with whiplash associated disorders.
VL  - 2
IS  - 6
ER  -

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