Ng Tze Siong, Pedler Ashley, Vicenzino Bill, Sterling Michele
†Physiotherapy Section, Department of Rehabilitation, National University Hospital, Singapore, Singapore *Division of Physiotherapy, School of Health and Rehabilitation Sciences §Centre for Clinical Excellence in Spinal Pain, Injury and Health, Division of Physiotherapy, The University of Queensland, St Lucia ‡Centre of National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Herston, QLD, Australia.
Clin J Pain. 2014 May;30(5):436-42. doi: 10.1097/AJP.0b013e3182a03940.
Cultural differences in pain perception exist. Although chronic whiplash-associated disorder (WAD) is well investigated in western countries, little is known about its presentation in Singapore. We studied the neck motion and pain sensitivity in people with chronic WAD in Singapore.
Thirty chronic WAD participants (>3 mo, Neck Disability Index: 40% [SD 17%]) were age, sex, and ethnicity matched with 30 pain-free controls. All 60 participants underwent the following tests: active neck motion, pain thresholds (pressure, brachial plexus provocation test [BPPT], cold), cold pain tolerance, and conditioned pain modulation (CPM). The test stimulus of contact heat and conditioning stimulus of cold water immersion was used to assess CPM. Data were evaluated to determine differences between WAD and control groups.
Active neck motion (F1,29=80.02), pain thresholds of blunt pressure (F1,29=20.84), BPPT (F1,29=54.56), and cold (Z=-4.31) were significantly lower in participants with WAD (P<0.0001). Cold pressor pain tolerance was significantly lower in participants with WAD (Z=-2.89, P=0.02). A less efficacious CPM was also demonstrated in participants with WAD (F1,29=9.20, P=0.03). A combination of BPPT and cold hyperalgesia best predicted the WAD group (sensitivity=96.7%, specificity=96.7%).
These findings of sensory hypersensitivity and decreased neck motion in Singaporeans with chronic WAD are consistent with physical impairments reported in western populations.
疼痛感知存在文化差异。尽管慢性挥鞭样损伤相关疾病（WAD）在西方国家已得到充分研究，但对其在新加坡的表现知之甚少。我们研究了新加坡慢性WAD患者的颈部活动和疼痛敏感性。
30名慢性WAD参与者（病程>3个月，颈部残疾指数：40%[标准差17%]）在年龄、性别和种族上与30名无疼痛对照者相匹配。所有60名参与者均接受了以下测试：主动颈部活动、疼痛阈值（压力、臂丛神经激发试验[BPPT]、冷刺激）、冷痛耐受性和条件性疼痛调制（CPM）。采用接触热测试刺激和冷水浸泡条件刺激来评估CPM。对数据进行评估以确定WAD组和对照组之间的差异。
WAD参与者的主动颈部活动（F1,29=80.02）、钝性压力疼痛阈值（F1,29=20.84）、BPPT（F1,29=54.56）和冷刺激疼痛阈值（Z=-4.31）显著更低（P<0.0001）。WAD参与者的冷压痛耐受性也显著更低（Z=-2.89，P=0.02）。WAD参与者的CPM效果也较差（F1,29=9.20，P=0.03）。BPPT和冷痛觉过敏相结合能最好地预测WAD组（敏感性=96.7%特异性=96.7%）。
新加坡慢性WAD患者感觉超敏和颈部活动减少的这些发现与西方人群报告的身体损伤一致。
