Physical and psychological factors maintain long-term predictive capacity post-whiplash injury

Abstract

Higher initial levels of pain and disability, older age, cold hyperalgesia, impaired sympathetic vasoconstriction and moderate post-traumatic stress symptoms have been shown to be associated with poor outcome 6 months following whiplash injury. This study prospectively investigated the predictive capacity of these variables at a long-term follow-up. Sixty-five of an initial cohort of 76 acutely injured whiplash participants were followed to 2-3 years post-accident. Motor function (ROM; kinaesthetic sense; activity of the superficial neck flexors (EMG) during cranio-cervical flexion), quantitative sensory testing (pressure, thermal pain thresholds and brachial plexus provocation test), sympathetic vasoconstrictor responses and psychological distress (GHQ-28, TSK and IES) were measured. The outcome measure was Neck Disability Index (NDI) scores. Participants with ongoing moderate/severe symptoms at 2-3 years continued to manifest decreased ROM, increased EMG during cranio-cervical flexion, sensory hypersensitivity and elevated levels of psychological distress when compared to recovered participants and those with milder symptoms. The latter two groups showed only persistent deficits in cervical muscle recruitment patterns. Higher initial NDI scores (OR 1.00-1.1), older age (OR 1.00-1.13), cold hyperalgesia (OR 1.1-1.13) and post-traumatic stress symptoms (OR 1.03-1.2) remained significant predictors of poor outcome at long-term follow-up (r2=0.56). The robustness of these physical and psychological factors suggests that their assessment in the acute stage following whiplash injury will be important.

The clinical presentation of chronic whiplash and the relationship to findings of MRI fatty infiltrates in the cervical extensor musculature: a preliminary investigation

“…It is noteworthy that PPT_remote, in tandem with CPT, held in the regression model for TUF (P = 0.1). This may align with previous work demonstrating that chronic WAD can result in findings of not just local, but rather widespread abnormal pain processing [2,10,52]. However, the direction of the association between PPT_local, TF (P = 0.09) and TUF (P = 0.1) was inverse (e.g., those with higher fat content had higher thresholds) and this is more difficult to explain.…”

“…However, as these findings of fatty infiltrate were observed in the chronic state, the significance of these muscle changes with respect to outcomes such as pain and disability and recovery rates remains unclear. The participants of this study all showed concomitant sensory (hyperalgesia) and psychological disturbances that characterize and predict those with a complex, non-resolving injury [52]. These disturbances have not shown to feature in subjects with persistent non-traumatic neck disorders [48].…”

The rapid and progressive degeneration of the cervical multifidus in whiplash: A MRI study of fatty infiltration

“…1 Half of all those exposed to a MVC will never fully recover but have milder symptoms, 2 and 25% (~ 1 million) are expected to present with a complex clinical picture including severe-pain-related disability, 3 muscle degeneration, 4,5 sensory and motor disturbances, 6 muscle weakness, 7 and psychological distress. 6 A number of psychosocial factors (e.g., coping, expectations, anxiety and depression) have been identified as being associated with poor functional recovery. 2 Despite the presence of and recognition for these factors, current best multimodal treatments have not substantially influenced the rate of functional recovery.…”

Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: A pilot study

“…Several mechanisms such as altered central pain processing and central sensitization [8][9][10][11] and the role of cognitions and behaviors [12][13][14][15] have been suggested, and evidence that supports these theories is rising. The dearth of trials evaluating conservative treatments for patients with chronic WAD is striking.…”