Exercise-induced hypoalgesia after aerobic versus neck-specific exercise in people with acute/subacute whiplash-associated disorders: protocol for a randomised controlled trial

Abstract

IntroductionA disturbance in exercise-induced hypoalgesia (EIH) has been observed in patients with chronic whiplash-associated disorders (WAD). Yet, no studies have examined whether EIH occurs in people with acute/subacute WAD. This study will determine whether EIH occurs immediately after and 24 hours after aerobic exercise (AE) and neck-specific exercise (NSE) in people with acute/subacute WAD.Methods and analysisA randomised controlled trial has been designed and is reported in line with the Standard Protocol Items: Recommendations for Interventional Trials. EIH will be assessed immediately after and 24 hours after AE, NSE and a control intervention (randomly allocated). As dependent variables of the study, we will measure pressure pain thresholds measured over the region of the spinous process of C2 and C5, the muscle belly of the tibialis anterior and over the three main peripheral nerve trunks, Neck Pain Intensity, Neck-Disability Index, Pain Catastrophizing Scale, Tampa Scale Kinesiophobia-11, self-reported Leeds Assessment of Neuropathic Symptoms and Signs Scale.Ethics approval and disseminationEthical approval has been granted by the Ethics Committee from University Rey Juan Carlos (Madrid, Spain; reference number 0707202116721). The results of this study will be disseminated through presentations at scientific conferences and publication in scientific journals.Trial registration numberRBR-9tqr2jt, https://ensaiosclinicos.gov.br/observador/submissao/sumario/11551.

Exercise-Induced Hypoalgesia in Patients with Chronic Whiplash-Associated Disorders: Differences between Subgroups Based on the Central Sensitization Inventory

“…The inclusion criteria for participants were as follows: Dutch speaking, aged between 18 to 65 years, having experienced a whiplash trauma at least 3 months ago, and having experienced a mean pain score of 4 or more on a numeric rating scale of 10 over the last month, aligning with the criteria used in similar studies [1,26]. People were excluded if they fulfilled the criteria of a grade IV WAD injury defined by the Quebec Task Force classification (i.e., fracture or dislocation of the cervical spine) [35], were diagnosed with other chronic diseases (e.g., fibromyalgia, rheumatologic diseases, neurological diseases, psychiatric diseases, cardiovascular diseases, or diabetes mellitus), and had a history of neck or shoulder surgeries.…”

“…Persistent pain is common in chronic whiplash-associated disorders (WADs) [1][2][3][4][5][6]. The research indicates that performing exercise is beneficial for patients with various chronic pain conditions and positively influences pain severity, overall physical and mental health, and, therefore, the quality of life [6][7][8].…”

“…The response in chronic pain populations is more variable with pain sensitivity decreasing, remaining unchanged, or, in some cases, even increasing in response to exercise [9]. Patients with chronic WADs may also present with dysfunctional pain inhibition and there are inconclusive results regarding what is the most appropriate form of exercise, for example, aerobic versus isometric exercises, to reduce pain sensitivity in people with chronic WADs [1]. The research reveals impaired exercise-induced hypoalgesia in individuals with chronic WADs both at rest and after performing submaximal aerobic exercises [23][24][25][26][27].…”