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He Y, Gao J, Liu Y, Qian J. Global trends and hotspots related to whiplash injury: A visualization study. Medicine (Baltimore) 2024; 103:e38777. [PMID: 39029013 PMCID: PMC11398816 DOI: 10.1097/md.0000000000038777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
Whiplash injury, commonly occurring as a result of car accidents, represents a significant public health concern. However, to date, no comprehensive study has utilized bibliometric approaches to analyze all published research on whiplash injury. Therefore, our study aims to provide an overview of current trends and the global research landscape using bibliometrics and visualization software. We performed a bibliometric analysis of the data retrieved and extracted from the Web of Science Core Collection database in whiplash injury research up to December 31, 2022. Research articles were assessed for specific characteristics, such as year of publication, country/region, institution, author, journal, field of study, references, and keywords. We identified 1751 research articles in the analysis and observed a gradual growth in the number of publications and references. The United States (379 articles, 21.64%), Canada (309 articles, 17.65%), and Australia (280 articles, 16.00%) emerged as the top-contributing countries/regions. Among institutions, the University of Queensland (169 articles, 9.65%) and the University of Alberta (106 articles, 6.05%) demonstrated the highest productivity. "Whiplash," "Neck Pain," "Cervical Spine Disease," and "Whiplash-associated Disorders" are high-frequency keywords. Furthermore, emerging areas of research interest included traumatic brain injury and mental health issues following whiplash injury. The number of papers and citations has increased significantly over the past 2 decades. Whiplash injury research is characteristically multidisciplinary in approach, involving the fields of rehabilitation, neuroscience, and spinal disciplines. By identifying current research trends, our study offers valuable insights to guide future research endeavors in this field.
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Affiliation(s)
- Yaqi He
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
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Anarte-Lazo E, Abichandani D, Rodriguez-Blanco C, Bernal-Utrera C, Falla D. Headache features in people with whiplash associated disorders: A scoping review. Musculoskelet Sci Pract 2023; 66:102802. [PMID: 37357053 DOI: 10.1016/j.msksp.2023.102802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Whiplash-associated headache (WAH) is one of the most common symptoms after a whiplash injury, leading to high disability. Nevertheless, the clinical characteristics of WAH have not been well described. OBJECTIVE To synthesise the existing literature on the clinical characteristics of WAH. DESIGN Scoping review. METHODS The protocol for this scoping review was registered in Open Science Framework and the PRISMA extension for Scoping Reviews tool was used to ensure methodological and reporting quality. A systematic search was conducted in PubMed, EMBASE, CINAHL, Web of Science and Scopus. The search was performed by one author and the screening of articles was conducted by two authors independently. RESULTS A total of 11363 articles were initially identified and finally 26 studies were included in the review. Headache intensity was the most commonly reported feature. Headache duration, frequency and location were also reported in at least four studies. Few studies reported physical impairments that may be related to the presence of WAH. A differentiation with concussion characteristics was only performed in eight studies. CONCLUSION WAH appears to be of mild to moderate intensity, typically with episodes of short duration which is commonly experienced in the occipital region amongst other regions, and with a tendency to reduce in intensity over time.
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Affiliation(s)
- E Anarte-Lazo
- Doctoral Program in Health Sciences, University of Seville, Seville, Spain; Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - D Abichandani
- Department of Physiotherapy, Institute of Health and Social Care, London South Bank University, London, UK
| | - C Rodriguez-Blanco
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - C Bernal-Utrera
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
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Hayashi K, Miki K, Ikemoto T, Ushida T, Shiro Y, Tetsunaga T, Takasusuki T, Hosoi M, Yukioka M. Predictors of high-cost patients with acute whiplash-associated disorder in Japan. PLoS One 2023; 18:e0287676. [PMID: 37379284 DOI: 10.1371/journal.pone.0287676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION The proportion of neck injuries due to traffic accidents is increasing. Little is known about high-cost patients with acute whiplash-associated disorder (WAD). The present study aimed to investigate whether time to first visit for conventional medicine, multiple doctor visits, or alternative medicine could predict high-cost patients with acute WAD in Japan. METHODS Data from a compulsory, no-fault, government automobile liability insurance agency in Japan between 2014 and 2019 were used. The primary economic outcome was the total cost of healthcare per person. Treatment-related variables were assessed based on the time to first visit for conventional and alternative medicine, multiple doctor visits, and visits for alternative medicine. Patients were categorized according to total healthcare cost (low, medium, and high cost). The variables were subjected to univariate and multivariate analysis to compare high-cost and low-cost patients. RESULTS A total of 104,911 participants with a median age of 42 years were analyzed. The median total healthcare cost per person was 67,366 yen. The cost for consecutive medicine, for consecutive and alternative medicine, and total healthcare costs were significantly associated with all clinical outcomes. Female sex, being a homemaker, a history of WAD claim, residential area, patient responsibility in a traffic accident, multiple doctor visits, and visits for alternative medicine were identified as independent predictive factors for a high cost in multivariate analysis. Multiple doctor visits and visits for alternative medicine showed large differences between groups (odds ratios 2673 and 694, respectively). Patients with multiple doctor visits and visits for alternative medicine showed a significantly high total healthcare cost per person (292,346 yen) compared to those without (53,587 yen). CONCLUSIONS A high total healthcare cost is strongly associated with multiple doctor visits and visits for alternative medicine in patients with acute WAD in Japan.
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Affiliation(s)
- Kazuhiro Hayashi
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States of America
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Kenji Miki
- Center for Pain Management, Hayaishi Hospital, Osaka, Japan
- Faculty of Health Science, Osaka Yukioka College of Health Science, Ibaraki, Japan
- Department Rheumatology, Yukioka Hospital, Osaka, Japan
- Japan Pain Foundation, Tokyo, Japan
| | - Tatsunori Ikemoto
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Japan
| | - Takahiro Ushida
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
- Japan Pain Foundation, Tokyo, Japan
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Nagakute, Japan
| | - Yukiko Shiro
- Japan Pain Foundation, Tokyo, Japan
- Department of Pain Medicine, Aichi Medical University, Nagakute, Japan
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, Nagoya, Japan
| | - Tomoko Tetsunaga
- Japan Pain Foundation, Tokyo, Japan
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| | - Toshifumi Takasusuki
- Japan Pain Foundation, Tokyo, Japan
- Department of Anesthesiology, Dokkyo Medical University, Mibu, Japan
| | - Masako Hosoi
- Japan Pain Foundation, Tokyo, Japan
- Department of Psychosomatic Medicine and Multidisciplinary Pain Center, Kyushu University Hospital, Fukuoka, Japan
| | - Masao Yukioka
- Faculty of Health Science, Osaka Yukioka College of Health Science, Ibaraki, Japan
- Department Rheumatology, Yukioka Hospital, Osaka, Japan
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Wagner S, Renner N, Krause J, Perl M. [Distortion of the cervical spine : Pathophysiology, diagnostics, treatment and assessment]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:983-994. [PMID: 36376757 DOI: 10.1007/s00113-022-01248-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Distortion or whiplash trauma of the cervical spine is an injury pattern associated with motor vehicle collisions and typically occurs after rear impact collisions, but is not limited to this type of collision and accident. The vast majority of these injuries are low-grade injuries according to the Quebec Task Force (QTF) classification, whereby no objective morphological correlates can be determined in clinical and radiological examinations. The prognosis is predominantly favorable and the condition is self-limiting; however, care must be taken with respect to complex courses with chronic pain and the manifestation of neuropsychiatric complaints. Due to the mechanism of the accident this injury pattern is particularly frequent in accidents associated with third party liability insurance claims. The discrepancy between subjective complaints and the presence of objective findings is a particular challenge for the assessment by the medical expert.
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Affiliation(s)
- S Wagner
- Unfallchirurgische und Orthopädische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
| | - N Renner
- Unfallchirurgische und Orthopädische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - J Krause
- Unfallchirurgische und Orthopädische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - M Perl
- Unfallchirurgische und Orthopädische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland
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Lee CI, Son BC. Decompression of the Greater Occipital Nerve for Persistent Headache Attributed to Whiplash Accompanying Referred Facial Trigeminal Pain. World Neurosurg 2021; 155:e814-e823. [PMID: 34509676 DOI: 10.1016/j.wneu.2021.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Persistent headache attributed to whiplash (PHAW) is defined as a headache that occurs for the first time in close temporal relation to whiplash lasting more than 3 months. We investigated the results of decompression of the greater occipital nerve (GON) in patients with PHAW who presented with referred trigeminal facial pain caused by sensitization of the trigeminocervical complex) along with occipital headache. METHODS A 1-year follow-up study of GON decompression was conducted in 7 patients with PHAW manifesting referred facial trigeminal pain. The degree of pain reduction was analyzed using the numeric rating scale (NRS-11) and percent pain relief before and 1 year after surgery. Success was defined by at least 50% reduction in pain measured via NRS-11. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. Clinical characteristics of headache and facial pain and surgical findings were studied. RESULTS GON decompression was effective in all 7 patients with PHAW manifesting referred trigeminal pain, with a percent pain relief of 83.06 ± 17.30. The pain had disappeared in 3 of 7 patients (42.9%) within 6 months and no further treatment was needed. Patients' assessment of subjective improvement based on a 10-point Likert scale was 7.23 ± 1.25. It was effective in both occipital and facial pain. CONCLUSIONS Although chronic GON entrapment itself is an individual constitutional issue, postwhiplash inflammatory changes seem to trigger chronic occipital headaches in GON distribution and unexplained referred trigeminal pain caused by sensitization of the trigeminocervical complex.
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Affiliation(s)
- Chang-Ik Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Chul Son
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Catholic Neuroscience Institute, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
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Arandia IR, Di Paolo EA. Placebo From an Enactive Perspective. Front Psychol 2021; 12:660118. [PMID: 34149551 PMCID: PMC8206487 DOI: 10.3389/fpsyg.2021.660118] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
Due to their complexity and variability, placebo effects remain controversial. We suggest this is also due to a set of problematic assumptions (dualism, reductionism, individualism, passivity). We critically assess current explanations and empirical evidence and propose an alternative theoretical framework-the enactive approach to life and mind-based on recent developments in embodied cognitive science. We review core enactive concepts such as autonomy, agency, and sense-making. Following these ideas, we propose a move from binary distinctions (e.g., conscious vs. non-conscious) to the more workable categories of reflective and pre-reflective activity. We introduce an ontology of individuation, following the work of Gilbert Simondon, that allow us to see placebo interventions not as originating causal chains, but as modulators and triggers in the regulation of tensions between ongoing embodied and interpersonal processes. We describe these interrelated processes involving looping effects through three intertwined dimensions of embodiment: organic, sensorimotor, and intersubjective. Finally, we defend the need to investigate therapeutic interactions in terms of participatory sense-making, going beyond the identification of individual social traits (e.g., empathy, trust) that contribute to placebo effects. We discuss resonances and differences between the enactive proposal, popular explanations such as expectations and conditioning, and other approaches based on meaning responses and phenomenological/ecological ideas.
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Affiliation(s)
- Iñigo R. Arandia
- IAS-Research Center for Life, Mind and Society, University of the Basque Country, Leioa, Spain
- ISAAC Lab, Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - Ezequiel A. Di Paolo
- IAS-Research Center for Life, Mind and Society, University of the Basque Country, Leioa, Spain
- Ikerbasque-Basque Foundation for Science, Bilbao, Spain
- Center for Computational Neuroscience and Robotics, University of Sussex, Brighton, United Kingdom
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The Long-term Impact of Whiplash Injuries on Patient Symptoms and the Associated Degenerative Changes Detected Using MRI: A Prospective 20-year Follow-up Study Comparing Patients with Whiplash-associated Disorders with Asymptomatic Subjects. Spine (Phila Pa 1976) 2021; 46:710-716. [PMID: 33394988 DOI: 10.1097/brs.0000000000003901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A longitudinal, 20-year comparative study of patients with whiplash-associated disorders (WAD). OBJECTIVE The aim of this study was to clarify the long-term impact of WAD on patient symptoms and on magnetic resonance imaging (MRI) findings of the cervical spine, in comparison with asymptomatic volunteers. SUMMARY OF BACKGROUND DATA The long-term impact of WAD has not been fully elucidated. METHODS Between 1993 and 1996, we conducted a cross-sectional comparative study of 508 acute WAD patients and 497 asymptomatic volunteers, all of whom underwent MRI on cervical spine and physical examinations. For this 20-year follow-up comparative study, 75 WAD patients and 181 control subjects aged <60 years were recruited from the original cohort. The MRI findings, including discs' signal intensities, posterior disc protrusions, anterior dural compressions, spinal cord disc space narrowing, and foraminal stenoses, were evaluated using two to four numerical grades. The results of the WAD patients and control subjects were compared. RESULTS In this follow-up, the prevalence of shoulder stiffness (72.0% vs. 45.9%), headache (24.0% vs. 12.2%), and arm pain (13.3% vs. 3.9%) were significantly greater in WAD patients than in control subjects. The multiregression analysis revealed that a history of WAD was associated with shoulder stiffness (odds ratio [OR]: 3.36), headache (OR: 2.39), and arm pain (OR: 3.82). Although MRI findings in WAD patients were more degenerated than in control subjects in the initial study, all MRI findings were similar at the 20-year follow-up. There were no significant correlations between clinical cervical symptoms and progression in each MR finding in either group. CONCLUSION After 20 years, whiplash injuries significantly impacted the residual symptoms of shoulder stiffness, headache, and arm pain when compared with initially asymptomatic volunteers. The progression of degenerative changes in the cervical intervertebral discs after 20 years revealed no association with existing whiplash injuries, neither did the residual cervical-related symptoms.Level of Evidence: 3.
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Abstract
Neck pain and headache are 2 of the most common complications of whiplash injury. Therefore, we performed a systematic literature search on PubMed and Embase for publications reporting on the prevalence of neck pain and headache after whiplash injury. The literature search identified 2709 citations of which 44 contained relevant original data. Of these, 27 studies provided data for the quantitative analysis. For non-population-based studies, the present meta-analysis showed that a pooled relative frequency of neck pain was 84% confidence interval (68%-95%) and a pooled relative frequency of headache was 60% (46%-73%), within 7 days after whiplash injury. At 12 months after injury, 38% (32%-45%) of patients with whiplash still experienced neck pain, while 38% (18%-60%) of whiplash patients reported headache at the same time interval after injury. However, we also found considerable heterogeneity among studies with I-values ranging from 89% to 98% for the aforementioned meta-analyses. We believe that the considerable heterogeneity among studies underscores the need for clear-cut definitions of whiplash injury and standardized reporting guidelines for postwhiplash sequelae such as neck pain and headache. Future studies should seek to optimize these aspects paving the way for a better understanding of the clinical characteristics and natural course of whiplash-associated sequelae.
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Pohl H, Schubring-Giese M, Gantenbein AR. Can Anything Good Ever Come From Bearing Migraine Attacks? Suggestions for a Comprehensive Concept of Gain in Migraine. Curr Pain Headache Rep 2019; 23:90. [PMID: 31734850 DOI: 10.1007/s11916-019-0829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarise the current state of knowledge concerning known types of gain, the reasons why patients might seek it, as well as implications for headache disorders. RECENT FINDINGS Even though the subject has been studied in the past, it received less attention in recent years. There is no doubt that migraine is a highly disabling disorder. However, attacks sometimes may be beneficial for the migraine brain as a time-out from the daily routine. On the other hand, patients are often stigmatised as trying to satisfy other needs through their disease. These "other needs" may be the exaggerated seeking for attention and affection or an undue official sickness certificate and were named secondary gain. Striving for secondary gain denotes a behaviour that aims at benefiting from a disease in a way that is seen as inappropriate by others. The fact that the term has persisted in doctors' vocabulary for decades probably indicates that it designates a concept considered relevant by many. However, its usage is complicated by its usually imprecise definition. We found in a literature search that the strive for secondary gain is not limited to neurosis, might both occur consciously and unconsciously, sometimes may aim at financial gain and sometimes at social gain, and can either be potentially expected or readily obtained. This behaviour mainly seems to aim at shaping one's interactions with the environment. Its causes have not been elucidated completely, though, but "unrequited demands for love, attention and affection" have been postulated. The desire for social gain can be influenced by approaches based upon behavioural psychology. Broaching the issue of secondary gain may be beneficial in the daily clinical routine.
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Affiliation(s)
- Heiko Pohl
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
| | | | - Andreas R Gantenbein
- RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
- University of Zurich, Zurich, Switzerland
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Hayashi K, Miki K, Ikemoto T, Ushida T, Shibata M. Factors influencing outcomes among patients with whiplash-associated disorder: A population-based study in Japan. PLoS One 2019; 14:e0216857. [PMID: 31086388 PMCID: PMC6516647 DOI: 10.1371/journal.pone.0216857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 04/30/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Only a few, large population-based studies, have reported on whiplash-associated disorder (WAD). However, none of them have investigated the influence of crash severity on WAD outcome. In the present study, we aimed to determine whether crash severity predicts outcomes among patients with no-fault government insurance for acute WAD. Methods We utilized data from a compulsory, no-fault government automobile liability insurance agency in Japan. Individuals involved in a car accident between April 2001 and June 2015 with residual disabilities reported at the end of the treatment between October 2014 and September 2015 were included. Crash severity was assessed based on property damage costs, size of the other vehicle (large car, medium car, small car, or two-wheeled vehicles), and collision types (rear-end collision, contact with vehicle moving in the same direction, or in the opposite direction). Outcomes included the time to claim closure and the number of treatment visits. Results We analyzed data for a total of 52,251 individuals (28,571 male and 23,680 female) with a median age of 44 years (range: 2–95 years). The median time to claim closure was 220 days (range: 1–4,938 days), and the median number of treatment visits was 102 (range: 1–2,492). There was no significant association between outcomes and property damage costs or size of the other vehicle. Collision types exhibited no consistent association with outcomes. However, older age and affected body parts, in addition to the neck, were independent risk factors for delayed claim closure and a large number of visits, although, all odds ratios were low (often less than 2.0). Conclusions There was no obvious association of outcomes with property damage costs, size of the other vehicle, or collision types in acute WAD patients. Further studies should investigate the influence of psychological factors, compensation systems, and cultural conditions.
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Affiliation(s)
- Kazuhiro Hayashi
- Pain medicine and Research Information Center, Nonprofit Organization, Aichi, Japan
- Multidisciplinary Pain Center, Aichi Medical University, Aichi, Japan
- Department of Rehabilitation, Aichi Medical University Hospital, Aichi, Japan
| | - Kenji Miki
- Pain medicine and Research Information Center, Nonprofit Organization, Aichi, Japan
- Department of Pain Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Center for pain management, Hayaishi Hospital, Osaka, Japan
- * E-mail:
| | - Tatsunori Ikemoto
- Pain medicine and Research Information Center, Nonprofit Organization, Aichi, Japan
- Multidisciplinary Pain Center, Aichi Medical University, Aichi, Japan
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Aichi, Japan
| | - Takahiro Ushida
- Pain medicine and Research Information Center, Nonprofit Organization, Aichi, Japan
- Multidisciplinary Pain Center, Aichi Medical University, Aichi, Japan
- Institute of Physical Fitness, Sports Medicine and Rehabilitation, Aichi Medical University, Aichi, Japan
| | - Masahiko Shibata
- Pain medicine and Research Information Center, Nonprofit Organization, Aichi, Japan
- Department of Pain Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Adamec J, Bäumler H, Doukoff N, Graw M. Medizinische und rechtliche Aspekte bei der Begutachtung von Halswirbelsäulendistorsionen. Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0155-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kristoffersen ES, Stavem K, Lundqvist C, Russell MB. Excessive daytime sleepiness in secondary chronic headache from the general population. J Headache Pain 2017; 18:85. [PMID: 28815442 PMCID: PMC5559413 DOI: 10.1186/s10194-017-0794-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/04/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Excessive daytime sleepiness (EDS, defined as Epworth sleepiness scale score > 10) is a common symptom, with a prevalence of 10-20% in the general population. It is associated with headache and other chronic pain disorders. However, little is known about the prevalence of EDS among people with secondary chronic headaches. FINDINGS A total of 30,000 persons aged 30-44 from the general population was screened for headache by a questionnaire. The 633 eligible participants with self-reported chronic headache were interviewed and examined by a headache specialist who applied the International Classification of Headache Disorders with supplementary definitions for chronic rhinosinusitis and cervicogenic headache. A total of 93 participants had secondary chronic headache and completed the ESS. A total of 47 participants had chronic post-traumatic headache (CPTH) and/or cervicogenic headache (CEH), 39 participants had headache attributed to chronic rhinosinusitis (HACRS), while 7 had other secondary headaches. 23.3% of those with CPTH, CEH or HACRS reported EDS. In multivariable logistic regression analysis the odds ratios of EDS were not significantly different in people with CPTH/CEH or HACRS. CONCLUSION Almost one out of four subjects with secondary chronic headache reported EDS with no differences between the various secondary chronic headaches.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Head and Neck Research Group, Research Centre, Akershus University Hospital, PO Box 95, 1478, Lørenskog, Norway. .,Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Knut Stavem
- Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Nordbyhagen, Norway.,Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lørenskog, Norway.,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Nordbyhagen, Norway.,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Michael Bjørn Russell
- Head and Neck Research Group, Research Centre, Akershus University Hospital, PO Box 95, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Nordbyhagen, Norway
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Lee YC, Brooks F, Sandler S, Yau YH, Selby M, Freeman B. Most Cited Publications in Cervical Spine Surgery. Int J Spine Surg 2017; 11:19. [PMID: 28765803 DOI: 10.14444/4019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The purpose of this study is to perform a citation analysis on the most frequently cited articles in the topic of cervical spine surgery and report on the top 100 most cited publication in this topic. METHODS We used the Thomson Reuters Web of Science to search citations of all articles from 1945 to 2015 relevant to cervical spine surgery and ranked them according to the number of citations. The 100 most cited articles that matched the search criteria were further analyzed by number of citations, first author, journal, year of publication, country and institution of origin. RESULTS The top 100 cited articles in the topic of cervical spine surgery were published from 1952-2011. The number of citations ranged from 106 times for the 100th paper to 1206 times for the top paper. The decade of 1990-1999 saw the most publications. The Journal of Spine published the most articles, followed by Journal of Bone and Joint Surgery America. Investigators from America authored the most papers and The University of California contributed the most publications. Cervical spine fusion was the most common topic published with 36 papers, followed by surgical technique and trauma. CONCLUSION This article identifies the 100 most cited articles in cervical spine surgery. It has provided insight to the history and development in cervical spine surgery and many of which have shaped the way we practice today.
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Affiliation(s)
- Yu Chao Lee
- Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Yun-Hom Yau
- Royal Adelaide Hospital, Adelaide, Australia
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Noll-Hussong M. Whiplash Syndrome Reloaded: Digital Echoes of Whiplash Syndrome in the European Internet Search Engine Context. JMIR Public Health Surveill 2017; 3:e15. [PMID: 28347974 PMCID: PMC5387115 DOI: 10.2196/publichealth.7054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/22/2017] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background In many Western countries, after a motor vehicle collision, those involved seek health care for the assessment of injuries and for insurance documentation purposes. In contrast, in many less wealthy countries, there may be limited access to care and no insurance or compensation system. Objective The purpose of this infodemiology study was to investigate the global pattern of evolving Internet usage in countries with and without insurance and the corresponding compensation systems for whiplash injury. Methods We used the Internet search engine analytics via Google Trends to study the health information-seeking behavior concerning whiplash injury at national population levels in Europe. Results We found that the search for “whiplash” is strikingly and consistently often associated with the search for “compensation” in countries or cultures with a tort system. Frequent or traumatic painful injuries; diseases or disorders such as arthritis, headache, radius, and hip fracture; depressive disorders; and fibromyalgia were not associated similarly with searches on “compensation.” Conclusions In this study, we present evidence from the evolving viewpoint of naturalistic Internet search engine analytics that the expectations for receiving compensation may influence Internet search behavior in relation to whiplash injury.
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Affiliation(s)
- Michael Noll-Hussong
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
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16
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Abstract
Trauma is increasingly recognized as a factor in the development of chronic pain. Complex regional pain syndrome (CRPS) and phantom limb pain are distinct chronic conditions associated with trauma; they are also a challenge to treat and can lead to life-long suffering with a significant drain on healthcare resources. This review explores the underlying pathophysiology of acute pain after trauma and its transition to become chronic. In doing so it will provide a better understanding of treatment options. The evidence is increasing that treating injury well in the acute phase can prevent chronic pain from developing (Katz et al., 1996). Once chronic pain has developed it is more difficult to treat.
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Affiliation(s)
- N Curran
- Royal Free and University College Medical School, University College London, Centre of Anaesthesia, London, UK,
| | - B Brandner
- Royal Free and University College Medical School, University College London, Centre of Anaesthesia, London, UK
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Farmer S, Choi D. Spinal Column and Spinal Cord Disorders. Neurology 2016. [DOI: 10.1002/9781118486160.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - David Choi
- National Hospital for Neurology & Neurosurgery
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Nebel K, Stude P, Lüdecke C, Wiese H, Diener HC, Keidel M. Prospective PC-interactive Pressure Algesimetry of Post-Traumatic Neck pain after Whiplash Injury. Cephalalgia 2016; 25:205-13. [PMID: 15689196 DOI: 10.1111/j.1468-2982.2004.00842.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cervical pain is a prominent symptom in both acute whiplash injury and late whiplash syndrome. However, no systematic analysis of post-traumatic pain development covering several weeks has yet been performed in whiplash patients. It was the aim of the present study to analyse the duration and course of post-traumatic muscle pain due to whiplash injury in a prospective follow-up examination with short investigation intervals. A recovery of initially increased muscle pain after whiplash injury within 1 month was hypothesized. Pressure pain of the splenius and trapezius muscles was recorded using PC-interactive pressure algesimetry. Whiplash patients were investigated during the acute injury stage and after 3, 4, and 6 weeks and compared with matched controls. We found significantly increased pressure pain of the splenius and trapezius muscles in the acute stage of whiplash injury. After 4 weeks patients' scores of pain parameters were comparable to those of healthy control subjects. Within the patient group the first changes of pressure pain were observed within 3 (splenius) and 4 weeks (trapezius). For most patients the recovery dynamics lasted 4-6 weeks. A minority of patients did not show any improvement after 6 weeks. The present study shows that the dynamics of pressure pain due to whiplash injury can be quantified by means of PC-interactive pressure algesimetry. Our results confirm the clinical experience that the acute post-traumatic cervical syndrome normally subsides within weeks.
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Affiliation(s)
- K Nebel
- Department of Neurology, University of Essen, Essen, Germany.
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Trippolini MA, Dijkstra PU, Geertzen JHB, Reneman MF. Measurement Properties of the Spinal Function Sort in Patients with Sub-acute Whiplash-Associated Disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:527-36. [PMID: 25875331 PMCID: PMC4540759 DOI: 10.1007/s10926-014-9559-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE To extensively analyze the measurement properties the Spinal Function Sort (SFS) in patients with sub-acute whiplash-associated disorders (WAD). METHODS Three-hundred-two patients with WAD were recruited from an outpatient work rehabilitation center. Internal consistency was assessed by Cronbach's α. Construct validity was tested based on eight a priori hypotheses. Structural validity was measured with principal component analysis (PCA). Test-retest reliability and agreement was evaluated in a sub sample (n = 32) using intraclass correlation coefficient (ICC) and limits of agreement (LoA). The predictive validity of SFS for future work status at 1, 3, 6, and 12 months follow-up was determined by area under the curve (AUC) of receiver operating characteristics. Non-return to work (N-RTW) was defined with two cut-off points: workcapacity <50 and <100 %. RESULTS N-RTW decreased from 50%, 1 month follow-up, to 14%, 12 months follow-up. Cronbach's α was 0.98, PCA revealed evidence for unidimensionality. ICC was 0.86, LoA was ±33 points. Seven out of eight hypotheses for construct validity were not rejected. AUC reduced with a longer follow-up from 0.71 for 1 month to 0.61 at 12 months, for cut-off point <50%. For cut-off point <100% these values were 0.71 and 0.59. CONCLUSION In patients with sub-acute WAD test-retest reliability, internal consistency, construct- and structural validity of the SFS were adequate. LoA were substantial. Sensitivity to accurately predict N-RTW was poor. The predictive validity of the SFS for N-RTW of patients with sub-acute WAD from an outpatient work rehabilitation setting was only sufficient for the short term (1 month).
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Affiliation(s)
- M A Trippolini
- Department of Work Rehabilitation, Rehaklinik Bellikon, Suva Care, 5454, Bellikon, Switzerland,
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20
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Breaking news: Can the media make you sick? J Psychosom Res 2015; 79:173-4. [PMID: 26141749 DOI: 10.1016/j.jpsychores.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
The medicolegal challenges surrounding fibromyalgia (FM) arise from the subjectivity of symptoms, causal attribution and reported symptoms sufficiently severe to cause disablement. In the present article, the authors have endeavoured to provide clarification of some current issues by referencing the current literature, including the 2012 Canadian Fibromyalgia Guidelines. While FM is accepted as a valid condition, its diagnosis is vulnerable to misuse due to the subjectivity of symptoms. Without a defining cause, a physical or psychological event may be alleged to trigger FM, but adjudication of causation must be prudent. Although some individuals may experience severe symptoms, the prevalent societal concept of disablement due to FM must be tempered with the knowledge that working contributes to psychosocial wellbeing. Evidence provided in the present report may assist the courts in reaching decisions concerning FM.
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Zumsteg D, Wennberg R, Gütling E, Hess K. Whiplash and Concussion: Similar Acute Changes in Middle-Latency SEPs. Can J Neurol Sci 2014; 33:379-86. [PMID: 17168163 DOI: 10.1017/s0317167100005333] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective:Middle-latency somatosensory evoked potentials (SEPs) following median nerve stimulation can provide a sensitive measure of cortical function. We sought to determine whether the mechanical forces of whiplash injury or concussion alter normal processing of middle-latency SEPs.Methods:In a cross-sectional pilot study 20 subjects with whiplash were investigated (50% between 0.5-2 months and 50% between 6-41 months post injury) and compared to 83 healthy subjects using a standard middle-latency SEP procedure. In a subsequent prospective study subjects with either acute whiplash (n=13) or Grade 3 concussion (n=16) were investigated within 48 hours and again three months post injury.Results:In the pilot study the middle-latency SEP component N60 was significantly increased in the ten subjects investigated within two months after whiplash. In contrast, the ten subjects examined more than six months after injury showed normal latencies. In the prospective study N60 latencies were increased after whiplash and concussion when tested within 48 hours of injury. At three months, latencies were improved though still significantly different from controls post whiplash and concussion.Conclusion:Both whiplash injury and concussion alter processing of the middle-latency SEP component N60 in the acute post traumatic period. The acute changes appear to normalize between three-six months post injury. The SEP similarities suggest that the overlapping clinical symptomatology post whiplash and concussion may reflect a similar underlying mechanism of rotational mild traumatic brain injury.
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Affiliation(s)
- Dominik Zumsteg
- Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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Samji A, Thiagarajan V, Yeoh R. Whiplash injury and neuro-otological sequelae: An evidence based systematic review. HEARING, BALANCE AND COMMUNICATION 2014. [DOI: 10.3109/21695717.2014.910896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McLean SA, Ulirsch JC, Slade GD, Soward AC, Swor RA, Peak DA, Jones JS, Rathlev NK, Lee DC, Domeier RM, Hendry PL, Bortsov AV, Bair E. Incidence and predictors of neck and widespread pain after motor vehicle collision among US litigants and nonlitigants. Pain 2014; 155:309-321. [PMID: 24145211 PMCID: PMC3902045 DOI: 10.1016/j.pain.2013.10.016] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 09/11/2013] [Accepted: 10/15/2013] [Indexed: 11/22/2022]
Abstract
Debate continues regarding the influence of litigation on pain outcomes after motor vehicle collision (MVC). In this study we enrolled European Americans presenting to the emergency department (ED) in the hours after MVC (n=948). Six weeks later, participants were interviewed regarding pain symptoms and asked about their participation in MVC-related litigation. The incidence and predictors of neck pain and widespread pain 6weeks after MVC were compared among those engaged in litigation (litigants) and those not engaged in litigation (nonlitigants). Among the 859 of 948 (91%) participants completing 6-week follow-up, 711 of 849 (83%) were nonlitigants. Compared to nonlitigants, litigants were less educated and had more severe neck pain and overall pain, and a greater extent of pain at the time of ED evaluation. Among individuals not engaged in litigation, persistent pain 6weeks after MVC was common: 199 of 711 (28%) had moderate or severe neck pain, 92 of 711 (13%) had widespread pain, and 29 of 711 (4%) had fibromyalgia-like symptoms. Incidence of all 3 outcomes was significantly higher among litigants. Initial pain severity in the ED predicted pain outcomes among both litigants and nonlitigants. Markers of socioeconomic disadvantage predicted worse pain outcomes in litigants but not nonlitigants, and individual pain and psychological symptoms were less predictive of pain outcomes among those engaged in litigation. These data demonstrate that persistent pain after MVC is common among those not engaged in litigation, and provide evidence for bidirectional influences between pain outcomes and litigation after MVC.
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Affiliation(s)
- Samuel A McLean
- TRYUMPH Research Program, University of North Carolina, Chapel Hill, NC, USA Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA School of Dentistry, University of North Carolina, Chapel Hill, NC, USA Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA Department of Emergency Medicine, Spectrum Health System, Grand Rapids, MI, USA Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA Department of Emergency Medicine, Saint Joseph Mercy Health System, Ypsilanti, MI, USA Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA
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Schiltenwolf M, Beckmann NA. Whiplash disorder—is it a valid disease definition? Pain 2013; 154:2235. [DOI: 10.1016/j.pain.2013.06.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 06/27/2013] [Accepted: 06/28/2013] [Indexed: 10/26/2022]
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Cure by Fiat? Pain 2013; 154:2235-2237. [DOI: 10.1016/j.pain.2013.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 11/23/2022]
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Myrtveit SM, Wilhelmsen I, Petrie KJ, Skogen JC, Sivertsen B. What characterizes individuals developing chronic whiplash?: The Nord-Trøndelag Health Study (HUNT). J Psychosom Res 2013; 74:393-400. [PMID: 23597326 DOI: 10.1016/j.jpsychores.2013.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most individuals experiencing whiplash accidents recover rapidly. A considerable proportion, however, develop chronic symptoms. Psychological factors may slow recovery, possibly by increasing the likelihood of other symptoms being misattributed to, and amplified by the whiplash injury. We aimed to investigate how pre-injury mental and somatic symptoms, self-rated health, use of health-services and medications, health-behavior and socio-demographics predict the development of chronic whiplash. METHODS Data from two waves of a large, population based study (HUNT2 (baseline) and HUNT3) were used. Individuals reporting no whiplash at baseline were identified in HUNT3. Characteristics reported at baseline were compared between those who had developed chronic whiplash in HUNT3 (n=199) and those who had not (n=20,600), using Pearson's chi-squared tests, independent sample t-tests and logistic regression analyses. RESULTS Individuals developing chronic whiplash reported worse baseline health than those reporting no chronic whiplash. Poor self-rated health was a strong risk factor for subsequent chronic whiplash (OR=2.26, 95%CI: 1.68-3.04). Musculoskeletal pain also increased the risk (OR=1.21, 95%CI: 1.15-1.26), as did diffuse somatic symptoms (OR=2.09, 95%CI: 1.47-2.96), use of different health services (OR=1.31, 95%CI: 1.19-1.45), high use of medications (OR=1.28, 95%CI: 1.14-1.43) and symptoms of anxiety (OR=1.93, 95%CI: 1.39-2.68). Physical activity was protective (OR=0.67, 95%CI: 0.49-0.91). Most socio-demographic variables were not significantly associated with chronic whiplash. CONCLUSION Poor somatic and mental pre-injury health increased the risk of subsequent chronic whiplash. This suggests that chronic whiplash is not merely an organic disorder, and highlights the importance of individual expectations, symptom reattribution and amplification in development of chronic whiplash.
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Straube S, Croft P. Musculoskeletal pain in different occupational groups and different countries. Pain 2013; 154:773-774. [PMID: 23566371 DOI: 10.1016/j.pain.2013.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/12/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Sebastian Straube
- Department of Occupational, Social and Environmental Medicine, University Medical Center Göttingen, Waldweg 37 B, D-37073 Göttingen, Germany Professor of Primary Care Epidemiology, Arthritis Research UK Primary Care Centre, Keele University, ST5 5BG, UK
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Spearing NM, Connelly LB, Nghiem HS, Pobereskin L. Research on injury compensation and health outcomes: ignoring the problem of reverse causality led to a biased conclusion. J Clin Epidemiol 2012; 65:1219-26. [DOI: 10.1016/j.jclinepi.2012.05.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 05/06/2012] [Accepted: 05/09/2012] [Indexed: 11/25/2022]
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Schmidt P, Mayer TE, Drescher R. Delineation of alar ligament morphology: comparison of magnetic resonance imaging at 1.5 and 3 Tesla. Orthopedics 2012; 35:e1635-9. [PMID: 23127456 DOI: 10.3928/01477447-20121023-22] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Rupture of the alar and transverse ligaments due to whiplash injury can lead to upper cervical spine instability and subsequent neurological deterioration. The purpose of this study was to evaluate the normal anatomical variability of the alar ligaments in asymptomatic individuals with 3-T magnetic resonance imaging (MRI) and to compare the findings with standard 1.5-T examinations. Thirty-six participants underwent 3-T and 1.5-T MRIs. Magnetic resonance imaging findings were analyzed by classifying the alar ligaments with regard to the features detectability, signal intensity compared with muscle tissue, homogeneity, shape, spatial orientation, and symmetry. Delineation of the alar ligaments was significantly better on 3-T images, which were subjectively preferred for evaluation. The alar ligaments showed great variability. In the majority of participants, the alar ligaments were hypointense to muscle tissue, inhomogeneous, and different in shape and orientation. A statistically significantly higher number of ligaments appeared symmetric on 3-T imaging, indicating that 1.5-T imaging may underestimate the proportion of patients with normal, symmetric ligaments. This study demonstrates that high-field 3-T MRI provides better visualization of the alar ligaments compared with 1.5-T MRI. The higher signal-to-noise ratio allows detection of small signal changes. A great interindividual variety of the MRI morphology of the alar ligaments was found in participants with no history of neck trauma. Further studies with more participants are necessary to evaluate alar ligament pathologies in patients with a history of whiplash injury.
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Affiliation(s)
- Peter Schmidt
- Department of Neuroradiology, Institute of Radiology, University Hospital Jena, Jena, Germany.
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Myrtveit SM, Skogen JC, Wenzel HG, Mykletun A. Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK). BMC Psychiatry 2012; 12:129. [PMID: 22935146 PMCID: PMC3476995 DOI: 10.1186/1471-244x-12-129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 08/14/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study. METHODS Data from the Norwegian population-based "Hordaland Health Study" (HUSK, 1997-99); N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45). RESULTS Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p<0.05). The association was moderately strong (group difference of 0.60 standard deviation), only partly accounted for by confounding. For self-reported fractures symptoms were only slightly elevated. Recent whiplash was more commonly reported than whiplash-injury a long time ago, and the association of interest weakly increased with time since whiplash (r = 0.016, p = 0.032). CONCLUSIONS The increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model for chronic whiplash, challenges the standard injury model for whiplash, and is indicative evidence of chronic whiplash being a functional somatic syndrome.
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Affiliation(s)
- Solbjørg Makalani Myrtveit
- Faculty of medicine and dentistry, University of Bergen (UoB), Bergen, Norway,Division of Mental Health, Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Jens Christoffer Skogen
- Research Unit on Mental Health Epidemiology, Department of Health Promotion and Development, Faculty of Psychology, UoB, Bergen, Norway
| | - Hanne Gro Wenzel
- Division of Psychiatry, St Olav University Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnstein Mykletun
- Division of Mental Health, Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway,Research Unit on Mental Health Epidemiology, Department of Health Promotion and Development, Faculty of Psychology, UoB, Bergen, Norway,University of New South Wales, School of Psychiatry, Sydney, Australia
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Adams JP, Bell MDD, Bodenham AR. Quality and outcomes in anaesthesia: lessons from litigation. Br J Anaesth 2012; 109:110-22. [PMID: 22696560 DOI: 10.1093/bja/aes188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Healthcare litigation in the UK continues to grow at an alarming rate, with claims against anaesthetists and critical care physicians increasing each year. This has led to a huge financial burden for the taxpayer and a sharp increase in professional indemnity fees for individual doctors. Although such litigation should provide valuable information to educate practitioners and reduce future similar claims, there appear to be significant barriers preventing important lessons from being learned. Detailed learning opportunities are available only to the healthcare providers being sued or the expert witnesses employed to analyse the claims. Most practitioners have to rely on indemnifiers' case reports, closed-claim analyses, and ad hoc publications for information. In this review, we suggest ways in which important lessons from litigation could be brought to the attention of all clinicians. Currently, most clinicians are unable to determine whether key components of their practice such as consent, clinical decision-making, and documentation are of an acceptable standard for legal scrutiny. By reporting outcomes of Coroners' inquests, clinical and criminal negligence cases, and referrals to the General Medical Council, it would be hoped that more explicit standards of performance could be derived. Ultimately, this may not only improve patient safety, but protect practitioners from unjustifiable claims. Finally, given the critical importance of experts in the above process, we believe that a system for professional registration and regulation should be explored to ensure that they offer accurate, representative, and unbiased opinions and have the appropriate expertise in the subject matter to be analysed.
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Affiliation(s)
- J P Adams
- Department of Anaesthesia, The General Infirmary at Leeds, Leeds LS1 3EX, UK
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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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Delayed recovery in patients with whiplash-associated disorders. Injury 2012; 43:1141-7. [PMID: 22475071 DOI: 10.1016/j.injury.2012.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/10/2012] [Accepted: 03/04/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prognosis of whiplash injury has been found to be related to a number of sociodemographic, treatment and clinical factors. In the current study, we attempt to identify several novel prognostic factors for delayed recovery in whiplash-associated disorders (WADs), using a validated and reliable measure of recovery. PATIENTS AND METHODS Retrospective review of a large database of a national network of physiotherapy and rehabilitation service providers in Canada yielded 5581 individuals injured in motor vehicle collisions. Cases were grouped into 3 cohorts based on time lapsed between injury date and initial presentation. Acute (n=3075), early chronic (n=958) and chronic (n=1548) patient cohorts were compared regarding treatment outcome and relative distribution of 29 prognostic factors. Outcome was defined by a minimally important clinical change (10%) on a previously validated disability questionnaire between initial and discharge rehabilitation visits. RESULTS Analysis demonstrated positive outcomes to be proportionally fewer in the chronic cohort (52.1%) relative to the early chronic (61.4%), which was in turn lower than the acute cohort (72.3%). Furthermore, individuals presenting with chronic pain were more likely to: (1) be female; (2) present with lower limb pain or nonorganic signs; (3) have returned to work; (4) have retained a lawyer; or (5) have undergone previous spinal surgery, and were less likely to: (1) present with neck or midback pain; (2) live in Ontario or Nova Scotia; or (3) have modified duties upon return to work. Acute, early chronic and chronic cohorts were also found to differ in the distribution of several other prognostic factors at initial clinical visit. CONCLUSIONS Recovery in whiplash-associated disorder appears to be multifactorial with both medical and non-injury related factors influencing outcome. Further characterisation of these factors may prove invaluable in guiding future clinical treatment and referral practices.
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Spearing NM, Connelly LB, Gargett S, Sterling M. Does injury compensation lead to worse health after whiplash? A systematic review. Pain 2012; 153:1274-1282. [DOI: 10.1016/j.pain.2012.03.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 02/29/2012] [Accepted: 03/06/2012] [Indexed: 11/30/2022]
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Bostick GP, Brown CA, Carroll LJ, Gross DP. If they can put a man on the moon, they should be able to fix a neck injury: a mixed-method study characterizing and explaining pain beliefs about WAD. Disabil Rehabil 2012; 34:1617-32. [DOI: 10.3109/09638288.2012.656791] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aasethl K, Grandel RB, Benthl JŠ, Lundqvistl C, Russelll MB. 3-Year follow-up of secondary chronic headaches: The Akershus study of chronic headache. Eur J Pain 2012; 15:186-92. [DOI: 10.1016/j.ejpain.2010.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 05/12/2010] [Accepted: 06/01/2010] [Indexed: 11/28/2022]
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Chang JH. Complications of Traumatic Brain Injury - Post-traumatic Headache and Epilepsy. BRAIN & NEUROREHABILITATION 2012. [DOI: 10.12786/bn.2012.5.2.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jae Hyeok Chang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
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Harris IA, Young JM, Jalaludin BB, Solomon MJ. Predictors of neck pain after motor vehicle collisions: a prospective survey. J Orthop Surg (Hong Kong) 2011; 19:317-21. [PMID: 22184162 DOI: 10.1177/230949901101900311] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To identify possible predictors (psychosocial) of neck pain in patients with acute injuries following motor vehicle trauma. METHODS 221 male and 85 female patients aged 18 to 85 (mean, 38) years who had acute fractures of the humerus, radius, ulna, pelvis, femur, patella, tibia, talus or calcaneus following motor vehicle trauma were prospectively recruited. No patient sustained a cervical spine injury. Patients sustaining minor trauma were excluded. As putative predictors of neck pain, data relating to demographics, injury, socio-economic status, and compensation were collected at the time of presentation and at month 6. Neck pain was measured by adapting the bodily pain questions from the SF-36 general health survey. Simple unadjusted and multiple regression analyses were conducted. RESULTS; 232 (76%) of the 306 patients completed the 6-month questionnaire. In multiple regression analysis, neck pain at 6 months was significantly associated with female gender, having a primary level of education only, and use of a lawyer. CONCLUSION Adversarial legal and compensation involvement may attribute to the development and continuation of neck pain after motor vehicle trauma.
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Affiliation(s)
- Ian A Harris
- Department of Orthopaedics, and South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Liverpool, NSW, Australia.
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Potential processes involved in the initiation and maintenance of whiplash-associated disorders: discussion paper 3. Spine (Phila Pa 1976) 2011; 36:S322-9. [PMID: 22101752 DOI: 10.1097/brs.0b013e318238853f] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Nonsystematic review and discussion of the etiological processes involved in whiplash-associated disorders (WAD). OBJECTIVE To summarize the research and identify priorities for future research. SUMMARY OF BACKGROUND DATA Although there is convergent evidence of a peripheral lesion in some individuals after whiplash injury, in the majority of injured people, a lesion cannot be established with current imaging technology. Therefore, it is important to consider processes that underlie the initiation and maintenance of whiplash pain as this may allow for the development and testing of interventions to target these processes and improve outcomes. METHODS A nonsystematic review was performed to summarize current knowledge regarding potential etiological processes involved in the initiation and maintenance of WAD and to identify future research priorities. RESULTS There are several etiological processes potentially involved in the initiation and maintenance of WAD. These include augmented nociceptive processing, stress system responses, and psychosocial and sociocultural factors. Recent findings also indicate that morphological changes in the neck muscles of injured people show some association with poor recovery, but the mechanisms underlying these changes are not clear. Preliminary evidence indicates associations between these processes. Future research priorities include the following: more sophisticated investigation and analysis of interactions between the various processes; whether the modification of these processes is achievable and if modification can improve health outcomes; and to clarify factors involved in the initiation of whiplash pain versus those involved in symptom maintenance. CONCLUSION Research to date indicates that there are several physiological and psychological etiological processes that may underlie the initiation and maintenance of whiplash-related pain and disability. Further research is required to determine relationships and interactions between these factors and to determine whether their modification is possible and will improve outcomes after injury.
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Abstract
STUDY DESIGN A descriptive overview of the relevant literature and the introduction of a new psychological model. OBJECTIVE The fear-avoidance (FA) model and the potential importance of illness beliefs in post-traumatic neck pain are discussed. The causal beliefs-anxiety model is introduced as an adaptation of the FA model, emphasizing the critical role of illness beliefs. SUMMARY OF BACKGROUND DATA Although the FA model is most thoroughly used to investigate chronic low back pain, it seems also highly relevant as a starting point for other chronic pain conditions like whiplash. Kinesophobia and pain catastrophizing form critical components of the FA model. It has been shown that breaking the FA cycle by affecting the critical components of the model may be an effective method to prevent the development of chronicity. METHODS By using the FA model as a starting point, we present the causal beliefs-anxiety model and argue how this might help explain chronic whiplash symptoms and might provide clues for preventive interventions. RESULTS On experiencing muscular neck pain, catastrophizing may give rise to dysfunctional illness beliefs regarding the cause of this pain. The illness identity and other beliefs feed symptom expectation and attribution, as well as expectations regarding the course of muscular neck pain. These negative expectations can contribute to a less favorable outcome or may even cause symptoms. Therefore, it seems important to integrate the alleged role of illness beliefs in an adapted FA model, the "causal beliefs-anxiety model." CONCLUSION In clinical practice, it seems important to have insight into the patient's illness beliefs about the cause of the experienced symptoms. Health care professionals should be aware of the possible detrimental influence of dysfunctional illness beliefs. In the early stage, adequate explanation and information about the probable course may be sufficient to prevent the generation of dysfunctional illness beliefs thereby preventing the development of a chronic course. At the population level, educational campaigns that inform people about probable causes and realistic expectations regarding post-traumatic neck pain could provide an effective strategy for preventing chronic whiplash symptoms.
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Abstract
STUDY DESIGN Review article. OBJECTIVE To explain why the evidence that compensation-related factors lead to worse health outcomes is not compelling, either in general, or in the specific case of whiplash. SUMMARY OF BACKGROUND DATA There is a common view that compensation-related factors lead to worse health outcomes ("the compensation hypothesis"), despite the presence of important, and unresolved sources of bias. The empirical evidence on this question has ramifications for the design of compensation schemes. METHODS Using studies on whiplash, this article outlines the methodological problems that impede attempts to confirm or refute the compensation hypothesis. RESULTS Compensation studies are prone to measurement bias, reverse causation bias, and selection bias. Errors in measurement are largely due to the latent nature of whiplash injuries and health itself, a lack of clarity over the unit of measurement (specific factors, or "compensation"), and a lack of appreciation for the heterogeneous qualities of compensation-related factors and schemes. There has been a failure to acknowledge and empirically address reverse causation bias, or the likelihood that poor health influences the decision to pursue compensation: it is unclear if compensation is a cause or a consequence of poor health, or both. Finally, unresolved selection bias (and hence, confounding) is evident in longitudinal studies and natural experiments. In both cases, between-group differences have not been addressed convincingly. CONCLUSION The nature of the relationship between compensation-related factors and health is unclear. Current approaches to testing the compensation hypothesis are prone to several important sources of bias, which compromise the validity of their results. Methods that explicitly test the hypothesis and establish whether or not a causal relationship exists between compensation factors and prolonged whiplash symptoms are needed in future studies.
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Fragliche nosologische Validität des chronischen Halswirbelschleudertraumasyndroms. DER ORTHOPADE 2011; 41:147-52. [DOI: 10.1007/s00132-011-1868-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Reverse causality in the association between whiplash and symptoms of anxiety and depression: the HUNT study. Spine (Phila Pa 1976) 2011; 36:1380-6. [PMID: 21217426 DOI: 10.1097/brs.0b013e3181f2f6bb] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Longitudinal population-based cohort study. OBJECTIVE The aim of this study was to examine the possibility of reverse causality, that is, if symptoms of anxiety and depression are associated with incident self-reported whiplash injury. The clinical relevance of self-reported whiplash injury was evaluated by its association with subsequent disability pension award. SUMMARY OF BACKGROUND DATA Whiplash is associated with an increased level of anxiety and depressive symptoms. This increase in psychological distress is generally understood as the consequence of the accident and related whiplash. METHODS Longitudinal data from the HUNT study was used. Baseline measures of symptoms of anxiety and depression were used in prediction of incident whiplash injury self-reported at follow-up 11 years later. Incident disability pension award was obtained from a comprehensive national registry during 2-year follow-up after self-reported whiplash injury. RESULTS Case-level symptom load of anxiety and depression at baseline increased the likelihood of reporting incident whiplash at follow-up (odds ratio [OR] = 1.60, 95% confidence interval = 1.22-2.11). Self-reported whiplash increased the chances of a subsequent disability pension award (OR = 6.54), even in the absence of neck pain (OR = 3.48). CONCLUSION This is the first published study with a prewhiplash prospective evaluation of psychological status. Our findings are in conflict with previous research suggesting whiplash to be the cause of associated psychological symptoms rather than their consequence. Self-reported whiplash injury was clinically relevant as it independently increased subsequent disability pension award. The strength of this effect, even in the absence of neck pain, suggests the ascertainment of this diagnostic label, or factors associated with this, are important predictors of disability.
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Haneline MT. The notion of a "whiplash culture": a review of the evidence. J Chiropr Med 2011; 8:119-24. [PMID: 19703667 DOI: 10.1016/j.jcm.2009.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 04/13/2009] [Accepted: 04/16/2009] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Most whiplash patients eventually recover, although some are left with ongoing pain and impairment. Why some develop long-term symptoms after whiplash, whereas others do not, is largely unknown. One explanation blames the cultural expectations of the population wherein the injury occurred, engendering the moniker whiplash culture. The purpose of this review was to locate and discuss studies that were used as a basis for developing the whiplash culture concept and to evaluate its plausibility. METHODS The PubMed database was searched using combinations of the terms whiplash culture, whiplash OR WAD, and chronic OR late OR long term. Search dates spanned from 1950 to June 2008. Filters were set to only retrieve English-language citations. Articles that dealt with the whiplash culture were selected and examined to determine which studies had been used to create the concept. RESULTS Nineteen articles discussed the cultural aspects of whiplash and were explored to determine which were used as a basis for the whiplash culture. Eight studies were found that met this final criterion. CONCLUSION There are many unanswered questions about the basis of chronic whiplash, and the notion of a whiplash culture is controversial. Chronic whiplash symptoms are surely not caused entirely by cultural issues, yet they are probably not entirely physical. Presumably, a tissue injury component exists in most chronic whiplash-associated disorder victims that becomes aggravated in those who are susceptible to biopsychosocial factors. As with many other controversial health care topics, the answer to the debate probably lies somewhere in the middle.
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Affiliation(s)
- Michael T Haneline
- Professor, Head of Chiropractic, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia; Adjunct Professor, Palmer College of Chiropractic West, San Jose, CA 95134
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Abstract
The cervical zygapophyseal joints, or facet joints, have long been implicated as a source of neck pain. This article examines the epidemiology of pain arising from these joints and relevant anatomy and histology. An emphasis on clinical findings, examination, and imaging are presented, as well as a focus on whiplash-associated pain.
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Affiliation(s)
- Alfred C Gellhorn
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105, USA.
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Myran R, Hagen K, Svebak S, Nygaard O, Zwart JA. Headache and musculoskeletal complaints among subjects with self reported whiplash injury: the HUNT-2 study. BMC Musculoskelet Disord 2011; 12:129. [PMID: 21651816 PMCID: PMC3127807 DOI: 10.1186/1471-2474-12-129] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 06/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the life-time prevalence of self reported whiplash injury and the relationship to chronic musculoskeletal complaints (MSCs) and headache in a large unselected adult population. METHODS Between 1995 and 1997, all inhabitants 20 years and older in Nord-Trondelag county in Norway were invited to a comprehensive health survey. Out of 92,936 eligible for participation, a total of 59,104 individuals (63.6%) answered the question about whiplash injury (whiplash). Among these, 46,895 (79.3%) responded to the questions of musculoskeletal complaints and headache. RESULTS The total life-time prevalence of self reported whiplash injury was 2.9%, for women 2.7% and for men 3.0%. There was a significant association between self reported whiplash injury and headache (OR = 2.1; 95% CI 1.8-2.4), and chronic MSCs (OR = 3.3; 95% CI 2.8-3.8), evident for all ten anatomical sites investigated. The association was most pronounced for those with a combination of headache and chronic MSC for both men (OR = 4.8; 95% CI 3.6-6.2) and women (OR = 5.2; 95% CI 3.7-7.1). CONCLUSIONS Subjects with self reported whiplash injury had significantly more headache and musculoskeletal complaints than those without, and may in part be due to selective reporting. The causal mechanism remains unclear and cannot be addressed in the present study design.
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Affiliation(s)
- Rigmor Myran
- Norwegian University of Science and Technology (NTNU), Norway.
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Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To evaluate the association between degree of signal changes in the alar ligaments on MRI with respect to pain and disability. SUMMARY OF BACKGROUND DATA Conflicting evidence exists whether areas of high-signal intensity in the alar ligaments on MRI are associated with pain and disability. METHODS A cross-sectional designed study of 173 subjects including a group with persistent whiplash associated disorder (WAD) Grade II after a car accident (n = 59), a group with chronic nontraumatic neck pain (n = 57) and a group without neck pain or previous neck trauma (n = 57). To assess pain and disability, all participants filled in the Brief Pain Inventory (BPI-intensity and BPI-interference), the European Quality of Life (EQ-5D and EQ VAS) and the Hospital Anxiety and Depression Rating Scale (HADS). High-resolution proton-weighted MR images in three planes were evaluated by two experienced neuroradiologists who were blinded to patient history and group allocation. The alar ligaments were evaluated according to a 4-point grading scale; 0 = low-signal intensity throughout the entire cross-section area, 1 = high-signal intensity in one third or less, 2 = high-signal intensity in one third to two thirds, and 3 = high-signal intensity in two thirds or more of the cross-section area. RESULTS With respect to BPI and HADS, the scores were highest in the WAD group, intermediate in the chronic nontraumatic neck pain group, and lowest among controls. EuroQol scores were lowest in the WAD group, intermediate in the chronic nontraumatic neck pain group, and highest among controls (P < 0.001). There was, however, no significant correlation between the alar ligament changes and measures for pain and disability. CONCLUSION The previously reported assumption that changes in the alar ligaments detected on MRI are associated with pain and disability is not supported by this study. The diagnostic value and the clinical relevance of MR-detectable areas of high intensity in the alar ligaments remain questionable.
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Jones GT, Nicholl BI, McBeth J, Davies KA, Morriss RK, Dickens C, Macfarlane GJ. Role of road traffic accidents and other traumatic events in the onset of chronic widespread pain: Results from a population-based prospective study. Arthritis Care Res (Hoboken) 2011; 63:696-701. [DOI: 10.1002/acr.20417] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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