Altered thermal sensitivity in facial skin in chronic whiplash-associated disorders

Abstract

There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury. Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma. The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders (WADs) with both a qualitative method and quantitative sensory testing (QST). Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women. Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits. Seven test sites in the facial skin (overlying each trigeminal branch bilaterally, and the midpoint of the chin) were examined. The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds. For the WAD patients, the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy, whereas QST systematically showed significantly higher detection thresholds (i.e., decreased sensitivity) for both cold and warm stimuli. For the individuals who were assessed as having increased sensitivity in the qualitative assessment, the QST displayed either normal or higher thresholds, i.e., decreased sensitivity. The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method. The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.

New Concept of Whiplash Injuries Rehabilitation

“…Regardless of the dominant mechanism of trauma, the eventful and possibly chronic course of WAD is indeed a dysfunctional processing of the pain signal at the level of the spinal cord and upper cerebral centres with peripheral and central sensitization. It was confirmed by numerous experiments showing changes in cerebral regional blood distribution in functional MRI, increased sensitivity to both mechanical and thermal stimuli of patients with WAD similar to those encountered, among others in fibromyalgia and algodystrophy [19,20,21,22] .…”

Orofacial Neuralgia Following Whiplash-Associated Trauma: Case Reports and Literature Review

“…These mechanisms may be relevant in the six cases reported here, as none of the cases of WAD-associated orofacial neuralgia was found to have tissue damage at the site of pain. Altered thermal sensitivity in facial skin of chronic WAD caused by motor accident is detectable using quantitative sensory testing [31]. Additionally, minimal stimulation by light touching, and associated with eating, which represents mechanical stimulation, triggered severe pain in these six cases.…”

Walking the Tightrope: A Proposed Model of Chronic Pain and Stress

“…Quantitative sensory testing has been used to measure sensory functioning and pain perception in several chronic pain populations. Groups of individuals with fibromyalgia (Crettaz et al, 2013;Coppieters et al, 2016;Wodehouse et al, 2018), chronic type headache (Cathcart et al, 2008;Cathcart et al, 2012;Defrin, 2014), whiplash disorders (Scott et al, 2005;Häggman-Henrikson et al, 2013), musculoskeletal pain Clark et al, 2017), menstrual pain (Slater et al, 2015;Payne et al, 2019), and irritable bowel syndrome (Murray et al, 2004) have previously undergone QST after exposure to acute psychological stress. A majority of these studies examined the relationship between acute stress and pain perception in individuals with chronic pain versus healthy controls.…”