Modulation of cervical facet joint nociception and pain attenuates physical and psychological features of chronic whiplash: a prospective study

Smith, Ashley Dean, Jull, Gwendolen, Schneider, Geoff M., Frizzell, Bevan, Hooper, Robert A. and Sterling, Michele (2015) Modulation of cervical facet joint nociception and pain attenuates physical and psychological features of chronic whiplash: a prospective study. PM and R, 7 9: 913-921. doi:10.1016/j.pmrj.2015.03.014


Author Smith, Ashley Dean
Jull, Gwendolen
Schneider, Geoff M.
Frizzell, Bevan
Hooper, Robert A.
Sterling, Michele
Title Modulation of cervical facet joint nociception and pain attenuates physical and psychological features of chronic whiplash: a prospective study
Journal name PM and R   Check publisher's open access policy
ISSN 1934-1482
1934-1563
Publication date 2015-01-01
Sub-type Article (original research)
DOI 10.1016/j.pmrj.2015.03.014
Open Access Status Not yet assessed
Volume 7
Issue 9
Start page 913
End page 921
Total pages 9
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Language eng
Formatted abstract
Objective: To investigate changes in clinical (physical and psychological) features of individuals with chronic whiplash−associated disorder who had previously undergone cervical radiofrequency neurotomy at the time point when the effects of radiofrequency neurotomy had dissipated and pain returned.

Design: Prospective cohort observational trial of consecutive patients.

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

Patients: A total of 53 consecutive individuals with chronic whiplash−associated disorder.

Methods: Individuals underwent radiofrequency neurotomy and were assessed before radiofrequency neurotomy; at 1 and 3 months postprocedure, and then after the return of pain (approximately 10 months postprocedure).

Main Outcome Measurements: Quantitative sensory tests (pressure; thermal pain thresholds; brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement; craniocervical flexion test) were measured. Self-reported disability, psychological distress, pain catastrophization, and posttraumatic stress disorder symptoms also were measured.

Results: Upon the return of pain after radiofrequency neurotomy, levels of disability increased (P < .0001), and were no different to those before radiofrequency neurotomy (P = .99). There also was a significant deterioration in quantitative sensory testing measures and reduced cervical range of motion after the return of pain (all P < .05); all approaching values were recorded before radiofrequency neurotomy (P > .22). There were no significant changes in pressure hyperalgesia (P > .054) or craniocervical flexion test performance (P > .07), after the return of pain. Psychological distress and pain catastrophizing increased significantly after the return of pain (P < .01), and again were no different than measures taken prior to radiofrequency neurotomy (P > .13). However, there was no difference in number or severity of posttraumatic stress symptoms after the return of pain (P > .30).

Conclusions: Physical and psychological features of chronic whiplash−associated disorder are modulated dynamically with cervical radiofrequency neurotomy. These findings indicate that peripheral nociception is involved in the manifestations of chronic whiplash−associated disorder in this cohort of individuals.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes In press, corrected proof

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Health and Rehabilitation Sciences Publications
School of Medicine Publications
 
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