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Pinilla-Fernández I, Ríos-León M, Deelchand DK, Garrido L, Torres-Llacsa M, García-García F, Vidorreta M, Ip IB, Bridge H, Taylor J, Barriga-Martín A. Chronic neuropathic pain components in whiplash-associated disorders correlate with metabolite concentrations in the anterior cingulate and dorsolateral prefrontal cortex: a consensus-driven MRS re-examination. Front Med (Lausanne) 2024; 11:1404939. [PMID: 39156690 PMCID: PMC11328873 DOI: 10.3389/fmed.2024.1404939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/12/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Whiplash injury (WHI) is characterised by a forced neck flexion/extension, which frequently occurs after motor vehicle collisions. Previous studies characterising differences in brain metabolite concentrations and correlations with neuropathic pain (NP) components with chronic whiplash-associated disorders (WAD) have been demonstrated in affective pain-processing areas such as the anterior cingulate cortex (ACC). However, the detection of a difference in metabolite concentrations within these cortical areas with chronic WAD pain has been elusive. In this study, single-voxel magnetic resonance spectroscopy (MRS), following the latest MRSinMRS consensus group guidelines, was performed in the anterior cingulate cortex (ACC), left dorsolateral prefrontal cortex (DLPFC), and occipital cortex (OCC) to quantify differences in metabolite concentrations in individuals with chronic WAD with or without neuropathic pain (NP) components. Materials and methods Healthy individuals (n = 29) and participants with chronic WAD (n = 29) were screened with the Douleur Neuropathique 4 Questionnaire (DN4) and divided into groups without (WAD-noNP, n = 15) or with NP components (WAD-NP, n = 14). Metabolites were quantified with LCModel following a single session in a 3 T MRI scanner within the ACC, DLPFC, and OCC. Results Participants with WAD-NP presented moderate pain intensity and interference compared with the WAD-noNP group. Single-voxel MRS analysis demonstrated a higher glutamate concentration in the ACC and lower total choline (tCho) in the DLPFC in the WAD-NP versus WAD-noNP group, with no intergroup metabolite difference detected in the OCC. Best fit and stepwise multiple regression revealed that the normalised ACC glutamate/total creatine (tCr) (p = 0.01), DLPFC n-acetyl-aspartate (NAA)/tCr (p = 0.001), and DLPFC tCho/tCr levels (p = 0.02) predicted NP components in the WAD-NP group (ACC r 2 = 0.26, α = 0.81; DLPFC r 2 = 0.62, α = 0.98). The normalised Glu/tCr concentration was higher in the healthy than the WAD-noNP group within the ACC (p < 0.05), but not in the DLPFC or OCC. Neither sex nor age affected key normalised metabolite concentrations related to WAD-NP components when compared to the WAD-noNP group. Discussion This study demonstrates that elevated glutamate concentrations within the ACC are related to chronic WAD-NP components, while higher NAA and lower tCho metabolite levels suggest a role for increased neuronal-glial signalling and cell membrane dysfunction in individuals with chronic WAD-NP components.
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Affiliation(s)
- Irene Pinilla-Fernández
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Grupo de Sistemas Complejos, Universidad Politécnica de Madrid, Madrid, Spain
| | - Marta Ríos-León
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
| | - Dinesh Kumar Deelchand
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Leoncio Garrido
- Departamento de Química-Física, Instituto de Ciencia y Tecnología de Polímeros (ICTP-CSIC), CSIC, Madrid, Spain
| | - Mabel Torres-Llacsa
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Servicio de Radiodiagnóstico, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Fernando García-García
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Servicio de Radiodiagnóstico, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | | | - I. Betina Ip
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Holly Bridge
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Julian Taylor
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Harris Manchester College, University of Oxford, Oxford, United Kingdom
| | - Andrés Barriga-Martín
- Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Toledo, Spain
- Research Group in Spine Pathology, Orthopedic Surgery and Traumatology Unit, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Faculty of Medicine, University of Castilla La Mancha, Toledo, Spain
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De Pauw R, Coppieters I, Caeyenberghs K, Kregel J, Aerts H, Lenoir D, Cagnie B. Associations between brain morphology and motor performance in chronic neck pain: A whole-brain surface-based morphometry approach. Hum Brain Mapp 2019; 40:4266-4278. [PMID: 31222905 PMCID: PMC6865716 DOI: 10.1002/hbm.24700] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/27/2019] [Accepted: 05/29/2019] [Indexed: 12/15/2022] Open
Abstract
Changes in brain morphology are hypothesized to be an underlying process that drive the widespread pain and motor impairment in patients with chronic neck pain. However, no earlier research assessed whole-brain cortical morphology in these patients. This case-control study assesses group-differences in whole-brain morphology between female healthy controls (HC; n = 34), and female patients with chronic idiopathic neck pain (CINP; n = 37) and whiplash-associated disorders (CWAD; n = 39). Additionally, the associations between whole-brain morphology and motor performance including balance, strength, and neuromuscular control were assessed. Cortical volume, thickness, and surface area were derived from high resolution T1-weighted images. T2*-weighted images were obtained to exclude traumatic brain injury. Vertex-wise general-linear-model-analysis revealed cortical thickening in the left precuneus and increased volume in the left superior parietal gyrus of patients with CINP compared to HC, and cortical thickening of the left superior parietal gyrus compared to HC and CWAD. Patients with CWAD showed a smaller cortical volume in the right precentral and superior temporal gyrus compared to HC. ANCOVA-analysis revealed worse neuromuscular control in CWAD compared to HC and CINP, and in CINP compared to HC. Patients with CWAD showed decreased levels of strength and sway area compared to CINP and HC. Partial correlation analysis revealed significant associations between the volume of the precentral gyrus, and neuromuscular control and strength together with an association between the volume of the superior temporal gyrus and strength. Our results emphasize the role of altered gray matter alterations in women with chronic neck pain, and its association with pain and motor impairment.
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Affiliation(s)
- Robby De Pauw
- Department of Rehabilitation Sciences, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Iris Coppieters
- Physiotherapy‐ Human Physiology‐ and Anatomy KIMAVrije Universiteit BrusselBrusselsBelgium
- Pain in Motion International Research Group
| | - Karen Caeyenberghs
- School of Psychology, Faculty of Health SciencesAustralian Catholic UniversityBrisbaneQueenslandAustralia
| | - Jeroen Kregel
- Department of Rehabilitation Sciences, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Physiotherapy‐ Human Physiology‐ and Anatomy KIMAVrije Universiteit BrusselBrusselsBelgium
- Pain in Motion International Research Group
| | - Hannelore Aerts
- Department of Data Analysis, Faculty of Psychology and Educational SciencesGhent UniversityGhentBelgium
| | - Dorine Lenoir
- Department of Rehabilitation Sciences, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Physiotherapy‐ Human Physiology‐ and Anatomy KIMAVrije Universiteit BrusselBrusselsBelgium
- Pain in Motion International Research Group
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
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EPIDEMIOLOGY of NECK INJURIES ACCOMPANYING SPORT CONCUSSIONS in YOUTH OVER a 13-YEAR PERIOD IN a COMMUNITY-BASED HEALTHCARE SYSTEM. Int J Sports Phys Ther 2019; 14:334-344. [PMID: 31681492 DOI: 10.26603/ijspt20190334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The same trauma that produces concussion may also produce neck injury. The signs of concussion and neck injury are similar, and symptoms after acceleration-deceleration trauma to the head-neck complex do not accurately discriminate between them. Research on the epidemiology of neck injury among sport-concussed youth is sparse. Purpose The purpose of this study was to investigate the epidemiology of diagnosed neck injury in non-sport-related concussion (Non-SRC) versus sport-related concussion (SRC) in youth by age, sex, and sport. Study design Cross-sectional epidemiologic study. Methods De-identified data from community-based electronic health records over 13 years were extracted to analyze rates and characteristics of neck injuries among non-SRCs and SRCs in youth aged five to 21. Neck injury diagnosis prevalence rates and odds ratios were calculated to estimate risk of neck injury among concussed youth, comparing non-SRCs to SRCs by age and sex. Results Sixteen thousand, eight hundred eighty-five concussion records were extracted, of which 3,040 SRCs and 2,775 non-SRCs in youth aged five to 21 were identified by cross-filtering sport-related keywords (e.g., football, basketball, soccer, running, swimming, batting, horseback riding, skiing, etc.) with all ICD-9 and ICD-10 concussion codes. The prevalence of neck injuries diagnosed among SRCs (7.2%) was significantly different than the prevalence of neck injuries diagnosed among non-SRCs (12.1%, p < 0.000). Neck injury diagnoses were significantly more prevalent in females overall (p < 0.000) and among non-SRCs (p < 0.000). The prevalence of neck injury diagnoses was not significantly higher in concussed females versus concussed males with SRC (p = 0.164).Among youth aged five to 21 exposed to concussions, non-SRCs were more likely to be accompanied by a neck injury diagnosis than SRCs (OR 1.66; 95% CI 1.39 to 1.98; p < 0.000). Similarly, female-to-male neck injury proportion ratios were significantly higher in females in non-SRCs compared to SRCs (IPR 1.90, 95% CI 1.60 to 2.25, p < 0.000).Sports with highest prevalence of concussion differ from sports with highest prevalence of concussion-related neck injury in both sexes. Conclusions The overall prevalence of diagnosed neck injuries in youth was higher in non-SRCs compared to SRCs (12.1 vs. 7.2%, p < 0.001), with the highest prevalence at age 14 in both sexes. The risk of neck injury diagnosis accompanying concussion was significantly higher in females compared to males (6.1% difference; p < 0.000).
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Peolsson A, Karlsson A, Ghafouri B, Ebbers T, Engström M, Jönsson M, Wåhlén K, Romu T, Borga M, Kristjansson E, Bahat HS, German D, Zsigmond P, Peterson G. Pathophysiology behind prolonged whiplash associated disorders: study protocol for an experimental study. BMC Musculoskelet Disord 2019; 20:51. [PMID: 30711003 PMCID: PMC6359872 DOI: 10.1186/s12891-019-2433-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is insufficient knowledge of pathophysiological parameters to understand the mechanism behind prolonged whiplash associated disorders (WAD), and it is not known whether or not changes can be restored by rehabilitation. The aims of the projects are to investigate imaging and molecular biomarkers, cervical kinaesthesia, postural sway and the association with pain, disability and other outcomes in individuals with longstanding WAD, before and after a neck-specific exercise intervention. Another aim is to compare individuals with WAD with healthy controls. METHODS Participants are a sub-group (n = 30) of individuals recruited from an ongoing randomized controlled study (RCT). Measurements in this experimental prospective study will be carried out at baseline (before intervention) and at a three month follow-up (end of physiotherapy intervention), and will include muscle structure and inflammation using magnetic resonance imaging (MRI), brain structure and function related to pain using functional MRI (fMRI), muscle function using ultrasonography, biomarkers using samples of blood and saliva, cervical kinaesthesia using the "butterfly test" and static balance test using an iPhone app. Association with other measures (self-reported and clinical measures) obtained in the RCT (e.g. background data, pain, disability, satisfaction with care, work ability, quality of life) may be investigated. Healthy volunteers matched for age and gender will be recruited as controls (n = 30). DISCUSSION The study results may contribute to the development of improved diagnostics and improved rehabilitation methods for WAD. TRIAL REGISTRATION Clinicaltrial.gov Protocol ID: NCT03664934, initial release 09/11/2018.
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Affiliation(s)
- Anneli Peolsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden. .,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Anette Karlsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Center, and Department of Medical and Health Sciences, Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Maria Engström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Radiological Sciences, Linköping University, Linköping, Sweden
| | - Margaretha Jönsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden.,Herrgärdets Vårdcentral, Region Västmanland, Västerås, Sweden
| | - Karin Wåhlén
- Pain and Rehabilitation Center, and Department of Medical and Health Sciences, Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - Thobias Romu
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Magnus Borga
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | | | | | - Dmitry German
- Department of Physical Therapy, University of Haifa, Haifa, Israel
| | - Peter Zsigmond
- Department of Neurosurgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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Abstract
Synopsis There is considerable evidence to support the importance of cervical afferent dysfunction in the development of dizziness, unsteadiness, visual disturbances, altered balance, and altered eye and head movement control following neck trauma, especially in those with persistent symptoms. However, there are other possible causes for these symptoms, and secondary adaptive changes should also be considered in differential diagnosis. Understanding the nature of these symptoms and differential diagnosis of their potential origin is important for rehabilitation. In addition to symptoms, the evaluation of potential impairments (altered cervical joint position and movement sense, static and dynamic balance, and ocular mobility and coordination) should become an essential part of the routine assessment of those with traumatic neck pain, including those with concomitant injuries such as concussion and vestibular or visual pathology or deficits. Once adequately assessed, appropriate tailored management should be implemented. Research to further assist differential diagnosis and to understand the most important contributing factors associated with abnormal cervical afferent input and subsequent disturbances to the sensorimotor control system, as well as the most efficacious management of such symptoms and impairments, is important for the future. J Orthop Sports Phys Ther 2017;47(7):492-502. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7052.
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Ischebeck BK, de Vries J, Van der Geest JN, Janssen M, Van Wingerden JP, Kleinrensink GJ, Frens MA. Eye movements in patients with Whiplash Associated Disorders: a systematic review. BMC Musculoskelet Disord 2016; 17:441. [PMID: 27769215 PMCID: PMC5074000 DOI: 10.1186/s12891-016-1284-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background Many people with Whiplash Associated Disorders (WAD) report problems with vision, some of which may be due to impaired eye movements. Better understanding of such impaired eye movements could improve diagnostics and treatment strategies. This systematic review surveys the current evidence on changes in eye movements of patients with WAD and explains how the oculomotor system is tested. Methods Nine electronic data bases were searched for relevant articles from inception until September 2015. All studies which investigated eye movements in patients with WAD and included a healthy control group were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the Methodology Checklists provided by the Scottish Intercollegiate Guidelines Network. Results Fourteen studies out of 833 unique hits were included. Ten studies reported impaired eye movements in patients with WAD and in four studies no differences compared to healthy controls were found. Different methods of eye movement examination were used in the ten studies: in five studies, the smooth pursuit neck torsion test was positive, in two more the velocity and stability of head movements during eye-coordination tasks were decreased, and in another three studies the cervico-ocular reflex was elevated. Conclusions Overall the reviewed studies show deficits in eye movement in patients with WAD, but studies and results are varied. When comparing the results of the 14 relevant publications, one should realise that there are significant differences in test set-up and patient population. In the majority of studies patients show altered compensatory eye movements and smooth pursuit movements which may impair the coordination of head and eyes.
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Affiliation(s)
- Britta Kristina Ischebeck
- Spine and Joint Centre, Noordsingel 113, 3035 EM, Rotterdam, The Netherlands. .,Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands.
| | - Jurryt de Vries
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands.,Department of Manual Therapy, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | | | - Malou Janssen
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Maarten A Frens
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands.,Erasmus University College, Rotterdam, The Netherlands
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Abstract
While much is known regarding the pathophysiology surrounding concussion injuries in the acute phase, there is little evidence to support many of the theorized etiologies to post-concussion syndrome (PCS); the chronic phase of concussion occurring in ∼ 10-15% of concussed patients. This paper reviews the existing literature surrounding the numerous proposed theories of PCS and introduces another potential, and very treatable, cause of this chronic condition; cervical spine dysfunction due to concomitant whiplash-type injury. We also discuss a short case-series of five patients with diagnosed PCS having very favorable outcomes following various treatment and rehabilitative techniques aimed at restoring cervical spine function.
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Affiliation(s)
- Cameron M Marshall
- a 1 Department of Graduate Studies, Canadian Memorial Chiropractic College , 6100 Leslie Street, Toronto, Ontario, 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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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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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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Sundström T, Guez M, Hildingsson C, Toolanen G, Nyberg L, Riklund K. Altered cerebral blood flow in chronic neck pain patients but not in whiplash patients: a 99mTc-HMPAO rCBF study. 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 2006; 15:1189-95. [PMID: 16614854 PMCID: PMC3233957 DOI: 10.1007/s00586-005-0040-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Accepted: 11/30/2005] [Indexed: 10/24/2022]
Abstract
A cross-sectional study to investigate regional cerebral blood flow (rCBF) in patients with chronic whiplash syndrome and chronic neck pain patients without previous history of trauma along with a healthy control group. Chronic neck pain is a common disorder and a history of cervical spine injury including whiplash trauma constitute a risk factor for persistent neck pain. The aetiology of the late whiplash syndrome is unknown with no specific diagnostic criteria based on imaging, physiological, or psychological examination. Earlier studies indicate a parieto-occipital hypoperfusion but it is unclear if the hypoperfusion represents a response to chronic pain. The rCBF was monitored in 45 patients with chronic neck pain: 27 cases with chronic whiplash syndrome and 18 age and gender matched cases with non-traumatic chronic neck pain. The rCBF was estimated with single-photon emission computed tomography (SPECT) using technetium-99m hexamethylpropylene amine oxime (HMPAO). The non-traumatic patients displayed rCBF changes in comparison with the whiplash group and the healthy control group. These changes included rCBF decreases in a right temporal region close to hippocampus, and increased rCBF in left insula. The whiplash group displayed no significant differences in rCBF in comparison with the healthy controls. The present study suggests different pain mechanisms in patients with chronic neck pain of non-traumatic origin compared to those with chronic neck pain due to a whiplash trauma.
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Affiliation(s)
- Torbjörn Sundström
- Department of Radiation Sciences, Diagnostic Radiology, Norrlands University Hospital, Umeå University, 901 85, Umea, Sweden.
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Affiliation(s)
- Patrick B Wood
- Department of Family Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71103, USA
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14
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The Relationship Between Phobic Travel Anxiety and the Physical Symptoms of Whiplash Injury. Rehabil Psychol 2004. [DOI: 10.1037/0090-5550.49.4.317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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