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. 2022 Jul 7:3:906638.
doi: 10.3389/fpain.2022.906638. eCollection 2022.

Cervical Motor and Nociceptive Dysfunction After an Acute Whiplash Injury and the Association With Long-Term Non-Recovery: Revisiting a One-Year Prospective Cohort With Ankle Injured Controls

Helge Kasch  1   2 , Tina Carstensen  2   3 , Sophie Lykkegaard Ravn  4   5 , Tonny Elmose Andersen  5 , Lisbeth Frostholm  2   3
Affiliations

Cervical Motor and Nociceptive Dysfunction After an Acute Whiplash Injury and the Association With Long-Term Non-Recovery: Revisiting a One-Year Prospective Cohort With Ankle Injured Controls

Helge Kasch et al. Front Pain Res (Lausanne). .

Abstract

Aims: To explore the development of cervical motor and nociceptive dysfunction in patients with whiplash (WPs) and non-recovery based on injury-related work disability 1-year after injury when compared with ankle-injured controls (ACs).

Methods: A 1-year observational prospective study examining consecutive WPs and age- and sex-matched ACs at 1 week,3 months, 6 months, and 1 year post-injury using semi-structured interviews; global pain rating (VAS0-10) and the pain rating index (PRI-T) and number-of-words-chosen (NWC) from the McGill Pain Questionnaire; examining nociceptive functioning using the cold pressor test (CPT), pressure algometry, and methodic palpation, and central pain processing using counter-stimulation; and examining motor functioning by active cervical range-of-motion (CROM), and neck strength [maximal voluntary contraction flexion/extension (MVC)]. One-year work disability/non-recovery was determined using a semi-structured interview.

Results: A total of 141 WPs and 40 ACs were included. Total pain rating index (PRI-T) NWC were higher in ACs after 1 week but higher in WPs after 3 months, 6 months, and 1 year. Ongoing global pain was higher in WPs after 1 week and after 3 and 6 months but not after 1 year. Pressure pain thresholds were reduced, and palpation was higher in the neck and jaw in WPs after 1 week but was not consistently different afterward from ACs. Cervical mobility was reduced in WPs after 1 week, 3 months, and 6 months but not after 1 year, and MVC was significantly reduced in WPs when compared with ACs after 1 week and 1 year but not after 3 and 6 months. One-year non-recovery was only encountered in 11 WPs and not in the AC group. Non-recovered WPs (N-WPs) had consistently significantly higher VAS0-10, PRI-T, NWC, reduced pressure pain thresholds, raised muscle-tenderness, reduced active cervical range-of-motion, reduced active-neck-flexion/extension, and reported higher neck disability scores than recovered WPs. Of special interest, there was increasing tenderness in trigeminal-derived muscles based on palpation scores, and marked reduction of PPDT was most pronounced in N-WPs when compared with recovered WPs and ACs.

Conclusion: Cervical motor dysfunction and segmental nociceptive sensitization were present from early after injury in WPs and prolonged in N-WPs. Differences in trigeminal and cervical motor and sensory function in N-WPs could be of interest for future treatment studies.

Keywords: acute whiplash injury; control group; motor dysfunction; nociceptive dysfunction; prospective observational study.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Methods applied. (A) Pressure algometry. (B) Methodic palpation. (C) Active cervical range of motion. (D) The cold pressor test. (E) Active neck strength extension/flexion.
Figure 2
Figure 2
(a) On-going pain (VAS) in whiplash and ankle-injured controls. (b) VAS in recovered and non-recovered whiplash and ankle-injured controls. (c) Total pain rating index, MPQ in whiplash and ankle-injured controls. (d) Total pain rating index in recovered and non-recovered whiplash and ankle-injured controls. (e) Number of words chosen, MPQ in whiplash and ankle-injured controls. (f) NWC in recovered and non-recovered whiplash and ankle-injured controls.
Figure 3
Figure 3
(a–f) Muscle tenderness assessed by pressure algometry. (g,h) Peripheral Tenderness [left third finger, proximal interphalangeal joint (PIP)]. (a) Total PPDT in whiplash and ankle-injured controls. (b) Neck muscle PPDT in whiplash and ankle-injured controls. (c) Trigeminal muscle PPDT in whiplash and ankle-injured controls. (d) Total PPDT and recovery. (e) Neck muscle PPDT and recovery. (f) Trigeminal muscle PPDT and recovery. (g,h) Peripheral tenderness (left third finger, proximal interphalangeal joint (PIP). (g) Peripheral tenderness in whiplash and ankle-injured controls. (h) Recovery and peripheral joint sensitization (PPDT PIP).
Figure 4
Figure 4
(a–f) Muscle tenderness assessed by palpation. (a) Total palpation score in whiplash and ankle-injured controls. (b) Neck palpation score in whiplash and ankle-injured controls. (c) Trigeminal muscle palpation score in whiplash and ankle-injury. (d) Total palpation score and recovery. (e) Palpation score neck muscles and recovery. (f) Palpation score trigeminal muscles and recovery.
Figure 5
Figure 5
(a,b) Cold pressor pain. time-to-peak pain and post-exposure discomfort (VAS0−10). (c–e) Counter stimulation and recovery. (a) Time-to-peak pain (sec) in cold pressor test and recovery. (b) Discomfort (VAS) in cold pressor test and recovery. (c–e) Counter stimulation and recovery. (c) Counterstimulation difference in PPT before and during coldpressor test. (d) Counterstimulation PPT before cold pain. (e) Counterstimulation PPT during cold pain.
Figure 6
Figure 6
(a,b) Active Neck Mobility, CROM (degrees). (a) Cervical neck mobility in whiplash and ankle-injured controls. (b) Active cervical range of motion and recovery.
Figure 7
Figure 7
(a,b) Maximal Voluntary Contraction, (kPa). (a) Total MVC (Nm) in whiplash and ankle-injured controls. (b) Total MVC and recovery.
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