Farrell Scott F, Armfield Nigel R, Kristjansson Eythor, Niere Ken, Christensen Steffan Wittrup McPhee, Sterling Michele
RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia.
NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Australia.
Pain. 2025 Jun 1;166(6):1328-1342. doi: 10.1097/j.pain.0000000000003461. Epub 2025 Mar 25.
Developmental trajectories for neck disability after whiplash injury have been identified. Their relationship to cold and mechanical sensitivity trajectories is not known. We aimed to (1) identify recovery trajectories of cold and mechanical sensitivity, (2) explore their codevelopment with disability trajectories, (3) identify predictors of sensitivity trajectories, and (4) explore codevelopment of cold and mechanical sensitivity trajectories. Participants (n = 233) were assessed at <1, 3, 6, and 12 months after whiplash injury. Outcomes were cold pain detection threshold (CPT at neck), pressure pain detection thresholds (PPT, neck C5, and tibialis anterior), and the Neck Disability Index. We used group-based trajectory models to identify postinjury recovery trajectories and multinominal logistic regression to explore associations between baseline characteristics and trajectory membership. We identified the following trajectory groups: CPT (low [50.0%], moderate [29.7%], and high [20.4%] sensitivity); PPT C5 (low [10.8%] and high [89.2%] sensitivity); and PPT tibialis anterior (low [23.9%], moderate [39.0%], and high [37.1%] sensitivity); all were stable over the 12 months. There was good correspondence between disability and cold sensitivity trajectory groups but not for mechanical sensitivity; cold and mechanical sensitivity trajectories were not well associated. Higher baseline pain predicted membership of the high cold sensitivity trajectory (RR 1.27, 95% CI 1.01-1.59) and hyperarousal symptoms predicted membership of the moderate cold sensitivity trajectory (RR 1.17, 95% CI 1.01-1.36). We found no associations between baseline characteristics and mechanical sensitivity. There is an interplay between cold allodynia, pain, and hyperarousal symptoms in development of ongoing disability after whiplash injury. Different mechanisms likely underlie cold and mechanical sensitivity.
挥鞭伤后颈部功能障碍的发展轨迹已被确定。但其与冷觉和机械敏感性轨迹的关系尚不清楚。我们旨在：（1）确定冷觉和机械敏感性的恢复轨迹；（2）探索它们与功能障碍轨迹的共同发展；（3）确定敏感性轨迹的预测因素；（4）探索冷觉和机械敏感性轨迹的共同发展。对233名参与者在挥鞭伤后<1个月、3个月、6个月和12个月进行评估。结果指标为冷痛检测阈值（颈部冷痛检测阈值）、压痛检测阈值（颈部C5和胫前肌压痛检测阈值）以及颈部功能障碍指数。我们使用基于组的轨迹模型来确定伤后的恢复轨迹，并使用多项逻辑回归来探索基线特征与轨迹类别之间的关联。我们确定了以下轨迹组：颈部冷痛检测阈值（低敏感性[50.0%]、中度敏感性[29.7%]和高敏感性[20.4%]）；C5压痛检测阈值（低敏感性[10.8%]和高敏感性[89.2%]）；以及胫前肌压痛检测阈值（低敏感性[23.9%]、中度敏感性[39.0%]和高敏感性[37.1%]）；所有这些在12个月内都是稳定的。功能障碍轨迹组与冷觉敏感性轨迹组之间存在良好的对应关系，但与机械敏感性轨迹组不存在；冷觉和机械敏感性轨迹之间关联不佳。较高的基线疼痛预测了高冷觉敏感性轨迹类别（风险比1.27，95%置信区间1.01 - 1.59），而高度觉醒症状预测了中度冷觉敏感性轨迹类别（风险比1.17，95%置信区间1.01 - 1.36）。我们未发现基线特征与机械敏感性之间存在关联。在挥鞭伤后持续性功能障碍的发展过程中，冷觉异常性疼痛、疼痛和高度觉醒症状之间存在相互作用。冷觉和机械敏感性可能有不同的机制。
