Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery

Sterling, Michele, Jull, Gwendolen A., Vicenzino, Bill and Kenardy, Justin (2003) Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain, 104 3: 509-517. doi:10.1016/S0304-3959(03)00078-2

Author Sterling, Michele
Jull, Gwendolen A.
Vicenzino, Bill
Kenardy, Justin
Title Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery
Journal name Pain   Check publisher's open access policy
ISSN 0304-3959
Publication date 2003-08
Sub-type Article (original research)
DOI 10.1016/S0304-3959(03)00078-2
Volume 104
Issue 3
Start page 509
End page 517
Total pages 9
Editor Allan I. Basbaum
Place of publication Amsterdam
Publisher Elsevier BV
Collection year 2003
Language eng
Subject C1
320705 Sensory Systems
730114 Skeletal system and disorders (incl. arthritis)
110906 Sensory Systems
110322 Rheumatology and Arthritis
Abstract Hypersensitivity to a variety of sensory Stimuli is a feature of persistent whiplash associated disorders (WAD). However, little is known about sensory disturbances from the time Of injury until transition to either recovery or symptom persistence. Quantitative sensory testing (pressure and thermal pain thresholds, the brachial plexus provocation test), the sympathetic vasoconstrictor reflex and psychological distress (GHQ-28) were prospectively measured in 76 whiplash Subjects within 1 month of injury and then 2, 3 and 6 months post-injury. Subjects were classified at 6 months post-injury using scores on the Neck Disability Index: recovered (<8), mild pain and disability (10-28) or moderate/severe pain and disability (>30). Sensory and sympathetic nervous system tests were also measured in 20 control subjects. All whiplash groups demonstrated local mechanical hyperalgesia in the cervica spine at 1 month post-injury. This hyperalgesia persisted in those with moderate/severe symptoms at 6 months but resolved by 2 months in those who had recovered or reported persistent mild symptoms. Only those with persistent moderate/severe symptoms at 6 months demonstrated generalised hypersensitivity to all sensory tests. These changes Occurred within 1 month of injury and remained Unchanged throughout the Study period. Whilst no significant group differences were evident for the sympathetic vasoconstrictor response, the moderate/severe group showed a tendency for diminished sympathetic reactivity. GHQ-28 scores of the moderate/severe group were higher than those of the other two groups. The differences in GHQ-28 did not impact on any of the sensory measures. These findings suggest that those with persistent moderate/severe symptoms at 6 months display, soon after injury, generalised hypersensitivity suggestive of changes in central pain processing mechanisms. This phenomenon did not Occur in those who recover or those with persistent mild symptoms. (C) 2003 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.
Keyword Anesthesiology
Clinical Neurology
Quantitative sensory testing
Sympathetic Nervous Function
Pressure-pain Thresholds
Laser-doppler Flowmetry
2-year Follow-up
Upper-limb Pain
Neck Injury
Q-Index Code C1

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Created: Wed, 15 Aug 2007, 02:07:03 EST