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Ghorayeb JH. The nosological classification of whiplash-associated disorder: a narrative review. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2021; 65:76-93. [PMID: 34035543 PMCID: PMC8128336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Whiplash-associated disorder (WAD) is the most common complaint and purported cause of chronic disability associated with motor vehicle collisions in North America. However, its construct validity remains controversial. This narrative review of the literature summarises the evidence underlying the most commonly theorised biological and psychosocial mechanisms of WAD pathogenesis. While the face validity of WAD is good, empirical evidence supporting the various constructs suggesting a causal link between a trauma mechanism and the development of symptoms is poor. Because individual expectations of recovery are outcome-predictive, future research is necessary to develop a better understanding of how to enhance expectancies in order to help affected motorists gain a greater sense of control over their health and wellbeing.
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Pertab JL, Merkley TL, Cramond AJ, Cramond K, Paxton H, Wu T. Concussion and the autonomic nervous system: An introduction to the field and the results of a systematic review. NeuroRehabilitation 2018; 42:397-427. [PMID: 29660949 PMCID: PMC6027940 DOI: 10.3233/nre-172298] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent evidence suggests that autonomic nervous dysfunction may be one of many potential factors contributing to persisting post-concussion symptoms. OBJECTIVE This is the first systematic review to explore the impact of concussion on multiple aspects of autonomic nervous system functioning. METHODS The methods employed are in compliance with the American Academy of Neurology (AAN) and PRISMA standards. Embase, MEDLINE, PsychINFO, and Science Citation Index literature searches were performed using relevant indexing terms for articles published prior to the end of December 2016. Data extraction was performed by two independent groups, including study quality indicators to determine potential risk for bias according to the 4-tiered classification scheme of the AAN. RESULTS Thirty-six articles qualified for inclusion in the analysis. Only three studies (one Class II and two Class IV) did not identify anomalies in measures of ANS functioning in concussed populations. CONCLUSIONS The evidence supports the conclusion that it is likely that concussion causes autonomic nervous system anomalies. An awareness of this relationship increases our understanding of the physical impact of concussion, partially explains the overlap of concussion symptoms with other medical conditions, presents opportunities for further research, and has the potential to powerfully inform treatment decisions.
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Affiliation(s)
- Jon L. Pertab
- Neurosciences Institute, Intermountain Healthcare, Murray, UT, USA
| | - Tricia L. Merkley
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Kelly Cramond
- Summit Neuropsychology, Reno, NV, USA
- VA Sierra Nevada Healthcare System, Reno, NV, USA
| | - Holly Paxton
- Hauenstein Neurosciences of Mercy Health and Department of Translational Science and Molecular Medicine, Michigan State University, MI, USA
| | - Trevor Wu
- Hauenstein Neurosciences of Mercy Health and Department of Translational Science and Molecular Medicine, Michigan State University, MI, USA
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Gold JE, Hallman DM, Hellström F, Björklund M, Crenshaw AG, Mathiassen SE, Barbe MF, Ali S. Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders. BMC Musculoskelet Disord 2017; 18:395. [PMID: 28899384 PMCID: PMC5596923 DOI: 10.1186/s12891-017-1694-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/24/2017] [Indexed: 01/04/2023] Open
Abstract
Background This study systematically summarizes quantitative imaging biomarker research in non-traumatic neck and shoulder musculoskeletal disorders (MSDs). There were two research questions: 1) Are there quantitative imaging biomarkers associated with the presence of neck and shoulder MSDs?, 2) Are there quantitative imaging biomarkers associated with the severity of neck and shoulder MSDs? Methods PubMed and SCOPUS were used for the literature search. One hundred and twenty-five studies met primary inclusion criteria. Data were extracted from 49 sufficient quality studies. Results Most of the 125 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. Only half controlled for potential confounders via exclusion or in the analysis. Approximately one-third reported response rates. In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. The literature synthesis suggested that neck muscle size may be decreased in neck pain, and trapezius myalgia and neck/shoulder pain may be associated with reduced vascularity in the trapezius and reduced trapezius oxygen saturation at rest and in response to upper extremity tasks. Reduced vascularity in the supraspinatus tendon may also be a feature in rotator cuff tears. Five of eight studies showed an association between a quantitative imaging marker and MSD severity. Conclusions Although research on quantitative imaging biomarkers is still in a nascent stage, some MSD biomarkers were identified. There are limitations in the articles examined, including possible selection bias and inattention to potentially confounding factors. Recommendations for future studies are provided. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1694-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith E Gold
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden. .,Gold Standard Research Consulting, 830 Montgomery Ave, Bryn Mawr, PA, USA.
| | - David M Hallman
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Fredrik Hellström
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Martin Björklund
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Albert G Crenshaw
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Svend Erik Mathiassen
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University Medical School, Philadelphia, PA, USA
| | - Sayed Ali
- Department of Radiology, Temple University Medical School, Philadelphia, PA, USA
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Sanchis-Gimeno JA, Perez-Bermejo M, Rios L, Llido S, Bastir M, Blanco-Perez E, Mata-Escolano F. Analysis of the relationship between the double transverse foramen and the possibility of developing clinical symptoms after whiplash. Clin Anat 2017; 30:761-766. [PMID: 28509423 DOI: 10.1002/ca.22897] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Juan A. Sanchis-Gimeno
- Department of Anatomy and Human Embryology; University of Valencia. Faculty of Medicine; Avda. Blasco Ibanez 15 Valencia Spain
| | - Marcelino Perez-Bermejo
- Department of Anatomy and Human Embryology; University of Valencia. Faculty of Medicine; Avda. Blasco Ibanez 15 Valencia Spain
- University San Vicente Martir; C/Espartero 7. Valencia Valencia Spain
| | - Luis Rios
- Department of Anatomy and Human Embryology; University of Valencia. Faculty of Medicine; Avda. Blasco Ibanez 15 Valencia Spain
- National Museum of Natural Sciences - Spanish National Research Council; C/Jose Gutierrez Abascal 2 Madrid Spain
| | - Susanna Llido
- Department of Anatomy and Human Embryology; University of Valencia. Faculty of Medicine; Avda. Blasco Ibanez 15 Valencia Spain
| | - Markus Bastir
- National Museum of Natural Sciences - Spanish National Research Council; C/Jose Gutierrez Abascal 2 Madrid Spain
| | - Esther Blanco-Perez
- Department of Anatomy and Human Embryology; University of Valencia. Faculty of Medicine; Avda. Blasco Ibanez 15 Valencia Spain
- Department of Radiology; University Hospital de La Ribera; Carretera Corbera km 1 Alzira, Valencia Spain
| | - Federico Mata-Escolano
- University San Vicente Martir; C/Espartero 7. Valencia Valencia Spain
- Department of Radiology; General University Hospital; Avda. Tres Cruces 2 Valencia Spain
- CT and MRI Unit; ERESA Clinic Research Foundation; Calle Marques de San Juan 6 Valencia Spain
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Vállez García D, Doorduin J, Willemsen ATM, Dierckx RAJO, Otte A. Altered Regional Cerebral Blood Flow in Chronic Whiplash Associated Disorders. EBioMedicine 2016; 10:249-57. [PMID: 27444853 PMCID: PMC5006659 DOI: 10.1016/j.ebiom.2016.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 01/02/2023] Open
Abstract
There is increasing evidence of central hyperexcitability in chronic whiplash-associated disorders (cWAD). However, little is known about how an apparently simple cervical spine injury can induce changes in cerebral processes. The present study was designed (1) to validate previous results showing alterations of regional cerebral blood flow (rCBF) in cWAD, (2) to test if central hyperexcitability reflects changes in rCBF upon non-painful stimulation of the neck, and (3) to verify our hypothesis that the missing link in understanding the underlying pathophysiology could be the close interaction between the neck and midbrain structures. For this purpose, alterations of rCBF were explored in a case-control study using H215O positron emission tomography, where each group was exposed to four different conditions, including rest and different levels of non-painful electrical stimulation of the neck. rCBF was found to be elevated in patients with cWAD in the posterior cingulate and precuneus, and decreased in the superior temporal, parahippocampal, and inferior frontal gyri, the thalamus and the insular cortex when compared with rCBF in healthy controls. No differences in rCBF were observed between different levels of electrical stimulation. The alterations in regions directly involved with pain perception and interoceptive processing indicate that cWAD symptoms might be the consequence of a mismatch during the integration of information in brain regions involved in pain processing. Differences of rCBF were explored by PET in cWAD patients and healthy volunteers exposed to four conditions. Changes in rCBF were observed in cWAD patients in regions involved in pain perception and interoceptive sensory information. These changes might be the consequence of a mismatch in the integration of interoceptive stimuli in pain processing regions.
In the past, published work on chronic whiplash-associated disorders (cWAD) has caused much confusion and discussion, yet functional imaging methods such as positron emission tomography (PET) have demonstrated a variety of different significant alterations in the perfusion or glucose utilization of the brain. The present study, using PET and the perfusion marker, H215O, is a step forward in whiplash research. It shows changes in perfusion in regions directly involved in pain perception and interoceptive sensory information, such as the insular cortex, precuneus, and posterior cingulate, indicating a mismatch in the integration of interoceptive information in pain processing brain regions.
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Affiliation(s)
- David Vállez García
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Huispostcode EB50, Postbus 30001, 9700 RB Groningen, The Netherlands.
| | - Janine Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Huispostcode EB50, Postbus 30001, 9700 RB Groningen, The Netherlands.
| | - Antoon T M Willemsen
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Huispostcode EB50, Postbus 30001, 9700 RB Groningen, The Netherlands.
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Huispostcode EB50, Postbus 30001, 9700 RB Groningen, The Netherlands.
| | - Andreas Otte
- Division of Biomedical Engineering, Department of Electrical Engineering and Information Technology, Offenburg University, D-77652 Offenburg, Germany.
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Davis CG. Mechanisms of chronic pain from whiplash injury. J Forensic Leg Med 2012; 20:74-85. [PMID: 23357391 DOI: 10.1016/j.jflm.2012.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 05/03/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
Abstract
This article is to provide insights into the mechanisms underlying chronic pain from whiplash injury. Studies show that injury produces plasticity changes of different neuronal structures that are responsible for amplification of nociception and exaggerated pain responses. There is consistent evidence for hypersensitivity of the central nervous system to sensory stimulation in chronic pain after whiplash injury. Tissue damage, detected or not by the available diagnostic methods, is probably the main determinant of central hypersensitivity. Different mechanisms underlie and co-exist in the chronic whiplash condition. Spinal cord hyperexcitability in patients with chronic pain after whiplash injury can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain pain in the absence of detectable tissue damage. Whiplash is a heterogeneous condition with some individuals showing features suggestive of neuropathic pain. A predominantly neuropathic pain component is related to a higher pain/disability level.
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Bakhtadze MA, Vernon H, Karalkin AV, Pasha SP, Tomashevskiy IO, Soave D. Cerebral Perfusion in Patients With Chronic Neck and Upper Back Pain: Preliminary Observations. J Manipulative Physiol Ther 2012; 35:76-85. [DOI: 10.1016/j.jmpt.2011.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 10/18/2011] [Accepted: 10/27/2011] [Indexed: 11/26/2022]
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Linnman C, Appel L, Söderlund A, Frans Ö, Engler H, Furmark T, Gordh T, Långström B, Fredrikson M. Chronic whiplash symptoms are related to altered regional cerebral blood flow in the resting state. Eur J Pain 2012; 13:65-70. [DOI: 10.1016/j.ejpain.2008.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 03/04/2008] [Accepted: 03/04/2008] [Indexed: 11/16/2022]
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Newberg AB, Hersh EV, Levin LM, Giannakopoulos H, Secreto SA, Wintering NA, Farrar JT. Double-blind, placebo-controlled, randomized pilot study of cerebral blood flow patterns employing SPECT imaging in dental postsurgical pain patients with and without pain relief. Clin Ther 2011; 33:1894-903. [PMID: 22101161 DOI: 10.1016/j.clinthera.2011.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Single-photon emission computed tomography (SPECT) has been employed in the study of altered regional cerebral blood flow (CBF) in experimental and chronic pain. CBF patterns have not been evaluated in patients with acute postoperative pain. OBJECTIVE The purpose of this pilot study was to employ SPECT to measure CBF distribution associated with postoperative dental pain and to compare these CBF patterns to subsequent images in the same patients who were experiencing pain relief versus continued or worsening pain who had received active or placebo analgesic interventions. The primary outcome measure was the percentage change in blood flow in various regions of interest. METHODS Twenty-two healthy individuals (10 males and 12 females, age range 20-29 years) who underwent the removal of ≥1 partial or full bony impacted mandibular third molars were evaluated for pain intensity as the local anesthesia dissipated, employing a 0 to10 numeric rating scale (0 = no pain; 10 = worst imaginable). When the subjects' pain level reached ≥4/10, they were injected intravenously with 260 MBq of technetium Tc 99m bicisate (ethyl cysteinate dimer). Under double-blind conditions and 10 minutes before being placed in the SPECT scanner, the first 10 subjects were randomized to receive intravenous ketorolac 15 mg or saline while the remaining 12 subjects were randomized to receive by mouth either ibuprofen 400 mg, ibuprofen 200 mg, acetaminophen 1000 mg, or placebo. One hour after drug administration, subjects were reevaluated for pain, injected with 925 MBq of technetium Tc 99m bicisate, given rescue medication if required, and then rescanned. CBF ratios were obtained for regions of interest and by normalizing to average whole brain activity. RESULTS Subjects generally had a moderate degree (mean [SD], 7.3% [4.0%]) of thalamic asymmetry on initial scans with pain; after treatment, subjects reporting worsening pain regardless of the intervention had higher thalamic asymmetry (8.1% vs 2.8%) than those reporting relief of pain. Subjects who reported reduced pain after the intervention had significantly different (P < 0.05) mean CBF changes compared with those reporting worsening pain in the left prefrontal cortex, left sensorimotor area, right anterior cingulate, and right caudate. CONCLUSIONS Acute postoperative dental pain was associated with moderate thalamic asymmetry that improved following successful pain management. Sustained or worsening pain was associated with increased CBF in brain regions associated with pain pathways, whereas pain relief was associated with decreased activity in the same areas.
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Affiliation(s)
- Andrew B Newberg
- Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Karibe H, Arakawa R, Tateno A, Mizumura S, Okada T, Ishii T, Oshima K, Ohtsu M, Hasegawa I, Okubo Y. Regional cerebral blood flow in patients with orally localized somatoform pain disorder: a single photon emission computed tomography study. Psychiatry Clin Neurosci 2010; 64:476-82. [PMID: 20727111 DOI: 10.1111/j.1440-1819.2010.02119.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Somatoform pain disorder is characterized by persistent and chronic pain at one or more sites without an associated general medical condition and in which psychological factors are thought to play a role. This study aimed to investigate the pathological features of somatoform pain disorder localized to the oral region by single photon emission computed tomography (SPECT). METHODS Ten patients (nine females and one male; average age 55.0 ± 14.4 years) having somatoform pain disorder with oral symptoms participated. SPECT was performed using N-isopropyl-4-[(123) I] iodoamphetamine intravenous injections, and regional cerebral blood flow (rCBF) was assessed by three-dimensional stereotactic surface projections. We also selected 12 healthy individuals (seven females and five males; average age 61.8 ± 13.2 years) to act as controls. RESULTS Both the patient and control groups showed no atrophy or infarction on CT or magnetic resonance imaging. The patient group showed higher rCBF in the subcortical area, especially in the thalamus and cingulate gyri, than the control group. In contrast, the patient group showed lower rCBF in the bilateral frontal and occipital lobes as well as in the left temporal lobe. CONCLUSIONS These results suggest that the biological process involved in somatoform pain disorder of the oral region is characterized by changes in limbic and cortical functions. The finding that somatoform pain disorder with oral symptoms is associated with brain functional changes will help to develop treatment regimes for this disorder and clarify the underlying pathology.
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Affiliation(s)
- Hiroyuki Karibe
- Department of Pediatric Dentistry, School of Life Dentistry, Nippon Dental University, Tokyo, Japan.
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Cicognani C, Vezzadini C, Battaglia S, Marliani AF, Zoni R. Un caso di encefalopatia posteriore reversibile (PRES), sindrome neurologica acuta da edema cerebrale reversibile su base multifattoriale. ITALIAN JOURNAL OF MEDICINE 2010. [DOI: 10.1016/j.itjm.2010.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Richter HO, Röijezon U, Björklund M, Djupsjöbacka M. Long-Term Adaptation to Neck/Shoulder Pain and Perceptual Performance in a Hand Laterality Motor Imagery Test. Perception 2010; 39:119-30. [DOI: 10.1068/p6418] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The effect of neck/shoulder pain on the performance in a hand laterality motor imagery test was studied. Responses to the Cooper and Shepard (1975, Journal of Experimental Psychology: Human Perception and Performance104 48–56) hand laterality test were explored in twenty-four individuals with chronic non-specific neck pain and twenty-one subjects with chronic neck pain of traumatic origin (whiplash-associated disorder). Twenty-two controls were also included in the study. Digitalised right- or left-hand stimuli were presented at five different stimulus angles (0°, 45° laterally, 90° laterally, 135° laterally, and 180°). The experimental task was to decide the laterality as fast and accurately as possible. The performance, both reaction time (RT) and accuracy, of the two experimental groups was contrasted with that of the control group. The main results revealed that the subjects afflicted with whiplash injury on the average exhibited a faster response pattern than symptom-free healthy controls. Despite their musculoskeletal deficits and experience of pain these volunteers also exhibited a preserved speed–accuracy tradeoff. Longer duration of time with symptoms of neck pain was, moreover, associated with progressively faster RTs. These results point to perceptual learning and may reflect different stages of adaptation to neck pain.
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Affiliation(s)
| | - Ulric Röijezon
- Alfta Research Foundation, Alfta, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, University of Umeå, Umeå, Sweden
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Rydevik B, Szpalski M, Aebi M, Gunzburg R. Whiplash injuries and associated disorders: new insights into an old problem. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008. [DOI: 10.1007/s00586-007-0484-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Owen DG, Bureau Y, Thomas AW, Prato FS, St Lawrence KS. Quantification of pain-induced changes in cerebral blood flow by perfusion MRI. Pain 2008; 136:85-96. [PMID: 17716820 DOI: 10.1016/j.pain.2007.06.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 06/15/2007] [Accepted: 06/15/2007] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to assess if the functional activation caused by painful stimuli could be detected with arterial spin labeling (ASL), which is a non-invasive magnetic resonance imaging (MRI) technique for measuring cerebral blood flow (CBF). Because ASL directly measures blood flow, it is well suited to pain conditions that are difficult to assess with current functional MRI, such as chronic pain. However, the use of ASL in neuroimaging has been hampered by its low sensitivity. Recent improvements in MRI technology, namely increased magnetic field strengths and phased array receiver coils, should enable ASL to measure the small changes in CBF associated with pain. In this study, healthy volunteers underwent two ASL imaging sessions, during which a painful thermal stimulus was applied to the left hand. The results demonstrated that the ASL technique measured changes in regional CBF in brain regions that have been previously identified with pain perception. These included bilateral CBF changes in the insula, secondary somatosensory, and cingulate cortices, as well as the supplementary motor area (SMA). Also observed were contralateral primary somatosensory and ipsilateral thalamic CBF changes. The average change in CBF for all regions of interest was 3.68ml/100g/min, ranging from 2.97ml/100g/min in ipsilateral thalamus to 4.91ml/100g/min in contralateral insula. The average resting global CBF was 54+/-9.7ml/100g/min, and there was no change in global CBF due to the noxious thermal stimulus.
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Affiliation(s)
- D G Owen
- Lawson Health Research Institute, St. Joseph's Health Care London, 268 Grosvenor Street, London, Ont., Canada N6A 4V2.
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