Department of Health Science and Technology, Faculty of Medicine, Aalborg University.
Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark.
Clin J Pain. 2021 Oct 1;37(10):730-739. doi: 10.1097/AJP.0000000000000970.
The objective of this study was to investigate the pain-sensory profile of patients with whiplash-associated disorders (WADs) prior and post 2 weeks of standardized rehabilitation and after a 6-month follow-up.
Twenty-two WAD participants (grade II; 14 women) and 22 sex-matched and age-matched healthy pain-free controls were enrolled. Pressure pain thresholds (PPTs) were assessed at local and distal muscles. Conditioned pain modulation (CPM) of PPTs was assessed using cuff pressure around the upper arm. Referred area of pain following supra-threshold pressure stimulation of the infraspinatus muscle was recorded on a body chart. Psychometric variables (pain intensity, area of perceived pain, pain catastrophizing, kinesiophobia, sleep problems, and depression level) were assessed. WAD group additionally completed the Neck Disability Index.
The WAD group demonstrated lower local PPTs compared with controls at all time points (P<0.05) and lower distal PPTs at baseline and at 2 weeks when compared with 6 months (within-group) (P<0.05). The WAD group had a reduced CPM response and larger induced referred pain areas compared with controls (P<0.05), while no within-group changes were observed at any time point. The WAD group reported higher pain intensity and perceived area of pain compared with controls at all time points (P<0.05) and a mean Neck Disability Index score of 41% at baseline, 16% at 2 weeks, and 4% at 6 months. Furthermore, the WAD group reported improvements in all other psychometric variables (P<0.05), although only pain catastrophizing levels were comparable to controls at 2 weeks.
PPTs but not CPM improved in the WAD group and were comparable to controls following 2 weeks following standardized rehabilitation, indicating that normalization of CPM may not be required to recover from WAD.
本研究旨在探讨颈挥鞭伤相关障碍（WAD）患者在标准化康复治疗前、后 2 周及 6 个月随访时的疼痛感觉特征。
共纳入 22 名 WAD 患者（II 级；14 名女性）和 22 名性别和年龄匹配的健康无痛对照者。评估局部和远端肌肉的压力疼痛阈值（PPT）。使用上臂袖带评估 PPT 的条件性疼痛调制（CPM）。记录冈下肌超阈压力刺激后的疼痛感受区域。评估心理计量学变量（疼痛强度、疼痛感知面积、疼痛灾难化、运动恐惧、睡眠问题和抑郁水平）。WAD 组还完成了颈部残疾指数（NDI）。
与对照组相比，WAD 组在所有时间点的局部 PPT 均较低（P<0.05），与 6 个月时相比，基线和 2 周时的远端 PPT 也较低（组内）（P<0.05）。与对照组相比，WAD 组的 CPM 反应降低，诱发的疼痛感受区域更大（P<0.05），但在任何时间点均未观察到组内变化。与对照组相比，WAD 组在所有时间点的疼痛强度和疼痛感知面积均较高（P<0.05），基线时的 NDI 平均得分为 41%，2 周时为 16%，6 个月时为 4%。此外，WAD 组在所有其他心理计量学变量方面均有改善（P<0.05），尽管只有在 2 周时疼痛灾难化水平才与对照组相当。
WAD 组的 PPT 有所改善，在标准化康复治疗后 2 周与对照组相当，这表明从 WAD 中恢复时，CPM 的正常化可能不是必需的。
