Kasch Helge, Carstensen Tina, Ravn Sophie Lykkegaard, Andersen Tonny Elmose, Frostholm Lisbeth
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Front Pain Res (Lausanne). 2022 Jul 7;3:906638. doi: 10.3389/fpain.2022.906638. eCollection 2022.
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).
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.
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 VAS, 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.
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.
探讨挥鞭样损伤患者（WPs）颈椎运动和伤害感受功能障碍的发展情况，以及与踝关节损伤对照组（ACs）相比，损伤后1年基于与损伤相关的工作残疾情况的未恢复情况。
一项为期1年的观察性前瞻性研究，在损伤后1周、3个月、6个月和1年对连续的WPs以及年龄和性别匹配的ACs进行半结构化访谈；采用视觉模拟评分法（VAS 0 - 10）进行整体疼痛评分，采用麦吉尔疼痛问卷的疼痛评分指数（PRI - T）和选择的词汇数量（NWC）；使用冷加压试验（CPT）、压力痛觉测定法和系统触诊检查伤害感受功能，使用对抗刺激检查中枢性疼痛处理；通过主动颈椎活动范围（CROM）和颈部力量[最大自主收缩屈伸（MVC）]检查运动功能。使用半结构化访谈确定1年的工作残疾/未恢复情况。
共纳入141例WPs和40例ACs。ACs在1周后的总疼痛评分指数（PRI - T）和NWC较高，但WPs在3个月、6个月和1年后较高。WPs在1周后、3个月和6个月后的持续整体疼痛较高，但1年后不高。WPs在1周后的压力痛阈值降低，颈部和下颌的触诊疼痛较高，但之后与ACs相比无持续差异。WPs在1周、3个月和6个月后的颈椎活动度降低，但1年后未降低，与ACs相比，WPs在1周和1年后的MVC显著降低，但3个月和6个月后未降低。1年未恢复仅在11例WPs中出现，AC组未出现。未恢复的WPs（N - WPs）的VAS、PRI - T、NWC始终显著更高，压力痛阈值降低，肌肉压痛增加，主动颈椎活动范围减小，主动颈部屈伸减小，且报告的颈部残疾评分高于恢复的WPs。特别值得注意的是，根据触诊评分，三叉神经源性肌肉的压痛增加，与恢复的WPs和ACs相比，N - WPs中PPDT的显著降低最为明显。
WPs在损伤后早期即出现颈椎运动功能障碍和节段性伤害感受敏化，且在N - WPs中持续存在。N - WPs中三叉神经、颈椎运动和感觉功能的差异可能对未来的治疗研究有意义。
