Sterling Michele, Jull Gwendolen, Vicenzino Bill, Kenardy Justin
The Whiplash Research Unit, Department of Physiotherapy, The University of Queensland, Brisbane 4072, Australia Department of Psychology, The University of Queensland, Brisbane 4072, Australia.
Pain. 2003 Aug;104(3):509-517. doi: 10.1016/S0304-3959(03)00078-2.
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 cervical 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.
对多种感觉刺激过敏是持续性挥鞭样损伤相关疾病（WAD）的一个特征。然而，从受伤时到恢复或症状持续期间的感觉障碍情况却鲜为人知。对76名挥鞭样损伤患者在受伤后1个月内、然后在受伤后2、3和6个月时，前瞻性地测量了定量感觉测试（压力和热痛阈值、臂丛神经激发试验）、交感缩血管反射和心理困扰（GHQ-28）。在受伤后6个月时，根据颈部功能障碍指数得分将受试者分类为：恢复（<8分）、轻度疼痛和功能障碍（10 - 28分）或中度/重度疼痛和功能障碍（>30分）。还对20名对照受试者进行了感觉和交感神经系统测试。所有挥鞭样损伤组在受伤后1个月时均表现出颈椎局部机械性痛觉过敏。这种痛觉过敏在6个月时中度/重度症状患者中持续存在，但在恢复或报告持续轻度症状的患者中在2个月时消失。只有在6个月时持续存在中度/重度症状的患者对所有感觉测试表现出全身性过敏。这些变化在受伤后1个月内出现，并在整个研究期间保持不变。虽然交感缩血管反应在各组之间没有明显差异，但中度/重度组显示出交感反应性降低的趋势。中度/重度组的GHQ-28得分高于其他两组。GHQ-28的差异对任何感觉测量指标均无影响。这些发现表明，在6个月时持续存在中度/重度症状的患者在受伤后不久就表现出全身性过敏，提示中枢性疼痛处理机制发生了变化。这种现象在恢复的患者或持续轻度症状的患者中并未出现。
