Cervical radiofrequency neurotomy reduces central hyperexcitability and improves neck movement in individuals with chronic whiplash

Smith, Ashley Dean, Jull, Gwendolen, Schneider, Geoff, Frizzell, Bevan, Hooper, Robert Allen and Stirling, Michele (2014) Cervical radiofrequency neurotomy reduces central hyperexcitability and improves neck movement in individuals with chronic whiplash. Pain Medicine, 15 1: 128-141. doi:10.1111/pme.12262


Author Smith, Ashley Dean
Jull, Gwendolen
Schneider, Geoff
Frizzell, Bevan
Hooper, Robert Allen
Stirling, Michele
Title Cervical radiofrequency neurotomy reduces central hyperexcitability and improves neck movement in individuals with chronic whiplash
Journal name Pain Medicine   Check publisher's open access policy
ISSN 1526-2375
1526-4637
Publication date 2014-01-01
Year available 2013
Sub-type Article (original research)
DOI 10.1111/pme.12262
Open Access Status
Volume 15
Issue 1
Start page 128
End page 141
Total pages 14
Place of publication Hoboken, NJ, United States
Publisher Wiley-Blackwell Publishing
Language eng
Abstract ObjectiveThis study aims to determine if cervical medial branch radiofrequency neurotomy reduces psychophysical indicators of augmented central pain processing and improves motor function in individuals with chronic whiplash symptoms.
Formatted abstract
Objective This study aims to determine if cervical medial branch radiofrequency neurotomy reduces psychophysical indicators of augmented central pain processing and improves motor function in individuals with chronic whiplash symptoms.

Design Prospective observational study of consecutive patients with healthy control comparison.

Setting Tertiary spinal intervention centre in Calgary, Alberta, Canada.

Subjects Fifty-three individuals with chronic whiplash associated disorder symptoms (Grade 2); 30 healthy controls.

Methods Measures were made at four time points: two prior to radiofrequency neurotomy, and 1- and 3-months post-radiofrequency neurotomy. Measures included: comprehensive quantitative sensory testing (including brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement, superficial neck flexor activity during the craniocervical flexion test). Self-report pain and disability measures were also collected. One-way repeated measures analysis of variance and Friedman's tests were performed to investigate the effect of time on the earlier measures. Differences between the whiplash and healthy control groups were investigated with two-tailed independent samples t-test or Mann–Whitney tests.

Results Following cervical radiofrequency neurotomy, there were significant early (within 1 month) and sustained (3 months) improvements in pain, disability, local and widespread hyperalgesia to pressure and thermal stimuli, nociceptive flexor reflex threshold, and brachial plexus provocation test responses as well as increased neck range of motion (all P < 0.0001). A nonsignificant trend for reduced muscle activity with the craniocervical flexion test (P > 0.13) was measured.

Conclusions Attenuation of psychophysical measures of augmented central pain processing and improved cervical movement imply that these processes are maintained by peripheral nociceptive input.
Keyword Whiplash
Radiofrequency neurotomy
Central sensitization
Quantitative sensory testing
Peripheral nociception
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article first published online: 18 OCT 2013

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Health and Rehabilitation Sciences Publications
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 13 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 29 Jan 2014, 22:16:39 EST by Adina Trutwin on behalf of Physiotherapy