Which of the following is the most appropriate initial management to maximize this patient's recovery?


The following vignette applies to the next 2 items.

A 37-year-old newspaper delivery truck driver, whom you have known for 2 years, comes to the office because of neck pain. Three days ago, his pickup truck was hit in the rear by a larger truck. The patient was dazed but not unconscious. He had
acute pain in his posterior neck and right shoulder area. He was transported to a nearby emergency department by ambulance where x-rays were normal. He was observed in the emergency department for 6 hours, fitted with a cervical collar, and given ibuprofen for pain. Prior to this accident he had been healthy, although he came to the office every few months with minor complaints, such as tinnitus and dyspepsia. No physical abnormalities were found at any of these past visits, and he responded to reassurance and symptomatic treatment. Today he is wearing the cervical collar and seems in distress. On physical examination, the nuchal area is diffusely tender to palpation, and the patient self-limits neck movements. Neurologic examination is normal. He tells you that he has already seen his attorney who believes that he has a good case against the other driver.

Item 1 of 2
Which of the following is the most appropriate initial management to maximize this patient’s recovery?

A) Declare him unable to work until his symptoms have ceased
B) Encourage him to forgo litigation
C) Increase the pain medication
D) Reassure him and continue the collar and ibuprofen therapy
E) Refer him for physical rehabilitation

Item 2 of 2

Based upon the medical literature and this patient’s history, which of the following is a correct statement about his recovery?
A) He will develop dependency on pain medication
B) He will need long-term care with visits every few months
C) He will only improve if he receives psychotherapy
D) Litigation may delay symptomatic recovery
E) Secondary gain will lead to malingering