Widespread Sensory Hypersensitivity Is a Feature of Chronic Whiplash-Associated Disorder but not Chronic Idiopathic Neck Pain

Objectives: To investigate sensory changes present in patients with chronic whiplash-associated disorders and chronic idiopathic neck pain using a variety of quantitative sensory tests to better understand the pain processing mechanisms underlying persistent symptoms. Methods: A case control study was used with 29 subjects with chronic whiplash-associated disorders, 20 subjects with chronic idiopathic neck pain, and 20 pain-free volunteers. Pressure pain thresholds were measured over the articular pillars of C2-C3, C5-C6, the median, radial, and ulnar nerve trunks in the arm and over a remote site, the muscle belly of tibialis anterior. Heat pain thresholds, cold pain thresholds, and von Frey hair sensibility were measured over the cervical spine, tibialis anterior, and deltoid insertion. Anxiety was measured with the Short-Form of the Spielberger State Anxiety Inventory. Results: Pressure pain thresholds were decreased over cervical spine sites in both subject groups when compared with controls (P < 0.05). In the chronic whiplash-associated disorders group, pressure pain thresholds were also decreased over the tibialis anterior, median, and radial nerve trunks (P < 0.001). Heat pain thresholds were decreased and cold pain thresholds increased at all sites (P < 0.03). No differencesin heat pain thresholds or cold pain thresholds were evident in the idiopathic neck pain group at any site compared with the control group (P > 0.27). No abnormalities in von Frey hair sensibility were evident in either neck pain group (P > 0.28). Discussion: Both chronic whiplash-associated disorders and idiopathic neck pain groups were characterized by mechanical hyperalgesia over the cervical spine. Whiplash subjects showed additional widespread hypersensitivity to mechanical pressure and thermal stimuli, which was independent of state anxiety and may represent changes in central pain processing mechanisms. This may have implications for future treatment approaches.

[1]  J. Kenardy,et al.  Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery , 2003, Pain.

[2]  A. Mykletun,et al.  A population study of anxiety and depression among persons who report whiplash traumas. , 2002, Journal of psychosomatic research.

[3]  M. Moog,et al.  The late whiplash syndrome: a psychophysical study , 2002, European Journal of Pain.

[4]  Birgitta Berglund,et al.  Quantitative and qualitative perceptual analysis of cold dysesthesia and hyperalgesia in fibromyalgia , 2002, Pain.

[5]  G. Jull,et al.  Pressure Pain Thresholds in Chronic Whiplash Associated Disorder: Further Evidence of Altered Central Pain Processing , 2002 .

[6]  Lars Arendt-Nielsen,et al.  Central Hypersensitivity in Chronic Pain After Whiplash Injury , 2001, The Clinical journal of pain.

[7]  R. Benoliel,et al.  Inflammation with no axonal damage of the rat saphenous nerve trunk induces ectopic discharge and mechanosensitivity in myelinated axons , 2001, Neuroscience Letters.

[8]  R. Ferrari.  Whiplash and Symptom Amplification , 2001, Pain.

[9]  E. Kosek,et al.  Abnormalities of somatosensory perception in patients with painful osteoarthritis normalize following successful treatment , 2000, European journal of pain.

[10]  R. Munglani.  Neurobiological Mechanisms Underlying Chronic Whiplash Associated Pain: The Peripheral Maintenance of Central Sensitization , 2000 .

[11]  J. Rhudy,et al.  Fear and anxiety: divergent effects on human pain thresholds , 2000, Pain.

[12]  Lars Arendt-Nielsen,et al.  Generalised muscular hyperalgesia in chronic whiplash syndrome , 1999, PAIN.

[13]  J. Greening,et al.  Minor peripheral nerve injuries: an underestimated source of pain? , 1998 .

[14]  Milton L Cohen,et al.  Psychophysical evidence for a neuropathic component of chronic neck pain , 1998, Pain.

[15]  R. Fillingim,et al.  Sex differences in the perception of noxious experimental stimuli: a meta-analysis , 1998, Pain.

[16]  N. Bogduk,et al.  Resolution of psychological distress of whiplash patients following treatment by radiofrequency neurotomy: a randomised, double-blind, placebo-controlled trial , 1997, Pain.

[17]  T. Coderre,et al.  Peripheral and central hyperexcitability: Differential signs and symptoms in persistent pain , 1997, Behavioral and Brain Sciences.

[18]  A. Light,et al.  The nervi nervorum , 1997 .

[19]  M. Merle,et al.  Cold and post-traumatic pain: modeling of the peripheral nerve message. , 1997, Bio Systems.

[20]  Jan Ekholm,et al.  Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms , 1996, Pain.

[21]  R. Helme,et al.  The effect of age on Aδ- and C-fibre thermal pain perception , 1996, Pain.

[22]  W. Spitzer,et al.  Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. , 1995, Spine.

[23]  N. Bogduk,et al.  The Prevalence of Chronic Cervical Zygapophysial Joint Pain After Whiplash , 1995, Spine.

[24]  R A Deyo,et al.  Physician Views About Treating Low Back Pain: The Results of a National Survey , 1995, Spine.

[25]  Wilfrid Jänig,et al.  Peripheral nerve injury triggers noradrenergic sprouting within dorsal root ganglia , 1993, Nature.

[26]  T. Marteau,et al.  The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). , 1992, The British journal of clinical psychology.

[27]  G. Champion,et al.  In search of the pathogenesis of refractory cervicobrachial pain syndrome: A deconstruction of the RSI phenomenon , 1992, The Medical journal of Australia.

[28]  T. Jensen,et al.  Measurements of human pressure-pain thresholds on fingers and toes , 1989, Pain.

[29]  C. Woolf,et al.  Recent advances in the pathophysiology of acute pain. , 1989, British journal of anaesthesia.

[30]  N. Bogduk,et al.  The cervical zygapophysial joints as a source of neck pain. , 1988, Spine.

[31]  N. Bogduk,et al.  The Innervation of the Cervical Intervertebral Discs , 1988, Spine.

[32]  Patrick D. Wall,et al.  Dynamic receptive field plasticity in rat spinal cord dorsal horn following C-primary afferent input , 1987, Nature.

[33]  R. Meyer,et al.  Evidence for different mechanisms of primary and secondary hyperalgesia following heat injury to the glabrous skin. , 1986, Brain : a journal of neurology.

[34]  H. Fields,et al.  Pain due to peripheral nerve damage , 1984, Neurology.

[35]  S. Ebbs,et al.  Normal Surface Anatomy , 1984 .

[36]  C. Woolf.  Evidence for a central component of post-injury pain hypersensitivity , 1983, Nature.

[37]  R. LaMotte,et al.  Peripheral neural mechanisms of cutaneous hyperalgesia following mild injury by heat , 1982, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[38]  D. Rall,et al.  Thresholds? , 1978, Environmental health perspectives.

[39]  H. Vernon.  The Neck Disability Index:: Patient Assessment and Outcome Monitoring in Whiplash , 1996 .

[40]  R. Helme,et al.  The effect of age on A delta- and C-fibre thermal pain perception. , 1996, Pain.

[41]  M. M. Taylor,et al.  Cervical Spinal Injuries , 1996 .