Doctoral Program in Health Sciences.
Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
Clin J Pain. 2024 Jun 1;40(6):349-355. doi: 10.1097/AJP.0000000000001209.
To understand whether pain-related factors soon after a whiplash injury can explain the presence of chronic headache.
A prospective study with a follow-up of 6 months was performed, including 42 patients with acute whiplash-associated disorders. Neck pain intensity, the Neck Disability Index, the Tampa Scale of Kinesiophobia, the Pain Catastrophizing Scale, and the Anxiety State-Trait Scale were assessed at baseline. Differences in clinical characteristics between those with and without headache at 6 months were determined. The relative risk of presenting with headache was evaluated. A logistic regression model was performed to assess which factors at baseline could explain the presence of headache at 6 months.
At 6 months, one-third of the sample presented with chronic headache. Significant differences were found for several outcome measures when people with and without headache were compared ( P <0.001). The highest relative risk of presenting with headache was found for moderate/severe levels of pain catastrophizing during the acute phase (RR=15.00, 95% CI=3.93, 57.22). The level of neck pain intensity and pain catastrophizing at baseline partially explained the presence of headache at 6 months ( R2 =0.627).
The risk of presenting with persistent headache attributed to a whiplash injury is increased when people present with higher neck pain intensity and pain catastrophizing soon after a whiplash injury. Evaluating neck pain intensity and pain catastrophizing at baseline may assist in identifying those more likely to develop chronic headache, potentially providing an opportunity for early targeted interventions.
了解挥鞭样损伤后早期的疼痛相关因素是否可以解释慢性头痛的存在。
进行了一项前瞻性研究，随访时间为 6 个月，纳入了 42 例急性挥鞭样损伤相关疾病患者。在基线时评估颈痛强度、颈部残疾指数、坦帕运动恐惧量表、疼痛灾难化量表和焦虑状态-特质量表。确定 6 个月时有无头痛的患者在临床特征上的差异。评估出现头痛的相对风险。进行逻辑回归模型以评估基线时哪些因素可以解释 6 个月时的头痛存在。
在 6 个月时，三分之一的样本出现慢性头痛。当比较有和无头痛的患者时，发现几个结局测量指标存在显著差异（P<0.001）。在急性阶段出现中/重度疼痛灾难化的患者出现头痛的相对风险最高（RR=15.00，95%CI=3.93,57.22）。基线时颈痛强度和疼痛灾难化的水平部分解释了 6 个月时头痛的存在（R2=0.627）。
当人们在挥鞭样损伤后早期出现较高的颈痛强度和疼痛灾难化时，出现持续性与挥鞭样损伤相关的头痛的风险增加。在基线时评估颈痛强度和疼痛灾难化可能有助于识别更可能出现慢性头痛的患者，从而有机会进行早期有针对性的干预。
