Is Traumatic and Non-Traumatic Neck Pain Associated with Brain Alterations? – A Systematic Review

Abstract

Background: Chronic neck pain affects 50% – 85% of people who have experienced an acute episode. This transition and the persistence of chronic complaints are believed to be mediated by brain alterations among different central mechanisms. Objectives: This study aimed to systematically review and critically appraise the current existing evidence regarding structural and functional brain alterations in patients with whiplash associated disorders (WAD) and idiopathic neck pain (INP). Additionally, associations between brain alterations and clinical symptoms reported in neck pain patients were evaluated. Study Design: Systematic review. Methods: The present systematic review was performed according to the PRISMA guidelines. PubMed, Web of Science, and Cochrane databases were searched. First, the obtained articles were screened based on title and abstract. Secondly, the screening was based on the full text. Risk of bias in included studies was investigated. Results: Twelve studies met the inclusion criteria. Alterations in brain morphology and function, including perfusion, neurotransmission, and blood oxygenation level dependent-signal, were demonstrated in chronic neck pain patients. There is some to moderate evidence for both structural and functional brain alterations in patients with chronic neck pain. In contrast, no evidence for structural brain alterations in acute neck pain patients was found. Limitations: Only 12 articles were included, which allows only cautious conclusions to be drawn. Conclusion: Brain alterations were observed in both patients with chronic WAD and chronic INP. Furthermore, more evidence exists for brain alterations in chronic WAD, and different underlying mechanisms might be present in both pathologies. In addition, pain and disability were correlated with the observed brain alterations. Accordingly, morphological and functional brain alterations should be further investigated in patients with chronic WAD and chronic INP with newer and more sensitive techniques, and associative clinical measurements seem indispensable in future research. Key words: Traumatic neck pain, idiopathic non-traumatic neck pain, brain alterations, magnetic resonance imaging, single photon emission computed tomography, photon emission tomography, chronic neck pain

Differences in white matter structure and cortical thickness between patients with traumatic and idiopathic chronic neck pain: Associations with cognition and pain modulation?

“…In contrast, CS is not a characteristic feature in CINP patients (Malfliet et al, ; Scott, Jull, & Sterling, ), and cognitive deficits are observed to a lesser extent compared with CWAD (Coppieters et al, ). A recent systematic review concerning brain alterations in WAD and INP, only found three studies investigating structural brain alterations exclusively in WAD (De Pauw, Coppieters, Meeus, Caeyenberghs, & Danneels, ), and one study reported altered GM volume in CWAD. However, alterations in cortical thickness and WM structure, and their association with cognitive deficits and CS, have never been investigated in patients with CWAD compared with CINP, which is a prominent research gap.…”

“…To guide the selection of cortical regions of interest (ROIs) from the Desikan parcellation scheme (Desikan et al, ) and the selection of WM tracts/ROIs from the Mori atlas (Mori et al, ) (see Figure ) evidence was retrieved from our systematic review appraising the evidence for brain alterations in INP and WAD (De Pauw et al, ), based on previous studies in patients with chronic pain or mild TBI examining GM morphological alterations (Cagnie et al, ; Cauda et al, ; Coppieters et al, ; Govindarajan et al, ; Kregel et al, ; Wang et al, ), demonstrating WM structural alterations, and regarding studies exploring associations between cortical thickness or WM structure, and measures of cognition and pain (Baek et al, ; Borsook et al, ; Chen, Blankstein, Diamant, & Davis, ; Coppieters et al, ; DeSouza, Hodaie, & Davis, ; Erpelding, Moayedi, & Davis, ; Kim et al, ; Koenig et al, ; Kraus et al, ; Lieberman et al, ; Lin et al, ; Ly et al, ; Mori et al, ; Piche et al, ; Sarikcioglu, Ozsoy, & Unver, ; Schwedt & Chong, ; Todd & Lempert, ; Upadhyay et al, ). In addition, only regions demonstrated to be mainly involved in processing pain or cognition or the combination thereof could be selected.…”

Are Pain Beliefs, Cognitions, and Behaviors Influenced by Race, Ethnicity, and Culture in Patients with Chronic Musculoskeletal Pain: A Systematic Review

“…In accordance with previous systematic reviews (3,41), the 2005 classification system of the Dutch Institute for Healthcare Improvement was used to rate the level of evidence of each study based on the study design and risk of bias assessment (Table 2). Afterwards, the studies were clustered according to the outcome measure and ethnic populations, and the strength of conclusion (ranging between 1 and 4) was determined for each of the clusters (Table 3).…”

Variability of the helical axis during active cervical movements in people with chronic neck pain

“…Besides pain, individuals with CNP may present with a number of disturbances in physical function including reduced proprioception, neuromuscular impairments, and difficulties with head-eye movement control (De Pauw et al, 2017;Della Casa et al, 2014;Ischebeck et al, 2017). Furthermore, people with CNP may experience fear of movement, symptoms of dizziness, a decrease of physical activity, and usually complain of disability during performance of daily activities (Cheng et al, 2015;Soderlund et al, 2017;Sremakaew et al, 2018;Yalcinkaya et al, 2017).…”