Cervical Motor and Nociceptive Dysfunction After an Acute Whiplash Injury and the Association With Long-Term Non-Recovery: Revisiting a One-Year Prospective Cohort With Ankle Injured Controls

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Abstract
Aims: Exploring the development of cervical motor and nociceptive dysfunction and recovery in patients (WPs) 1 year after whiplash injury compared with ankle-injured controls (ACs).
Methods: A 1-year observational prospective study examining consecutive WPs, and age- and sex-matched ACs at 1 week and 3, 6, and 12 months post-injury with semi-structured interviews; the McGill Pain Questionnaire; neurological examination, indicators of peripheral, segmental, and central nociceptive dysfunction: cold pressor test (CPT), pressure algometry, and methodic palpation; indicators of cervical motor dysfunction: active cervical range-of-motion (CROM), neck strength (maximal voluntary contraction flexion/extension (MVC). 12-month work disability was determined.
Results: A total of 141 WPs and 40 ACs were included. Total pain rating index (PRI-T) and number of words count were higher in ACs initially, however, higher in WPs after 3, 6, and 12 months. Ongoing pain was higher in WP initially and after 3, 6 months, but not 1 year. Pressure algometry and palpation showed segmental sensitization in the neck and jaw in WPs after 1 week, but not consistently after 3, 6, and 12 months. Time-to-peak pain was reduced and discomfort during cold pressor pain raised in WP as compared to AC.
Cervical motor dysfunction using CROM was found in WPs after 1 week, 3, 6, but not 12 months. MVC was significantly lower in WPs than in ACs after 1 week, 12 months but not 3 and 6 months.
One-year non-recovery was only encountered in 11 WPs. Non-recovered WPs had consistently significantly higher PRI-T, and neck, shoulder, head, and low-back pain (NRS), and reduction of time-to peak-pain on the cold pressor test (CPT), cervical nociceptive dysfunction by pressure algometry and palpation, and reduced active-cervical-range of-motion, reduced active-neck-flexion/extension, and reported higher neck disability scores than recovered WPs.
Conclusion: Cervical motor dysfunction and nociceptive sensitization were present from early after injury in WPs and prolonged in non-recovered WPs and should be targeted for both identification of poor recovery and for future assessment of head and neck injuries and treatment after acute whiplash.
Original languageEnglish
Article number906638
JournalFrontiers in Pain Research
Volume3
Number of pages12
ISSN2673-561X
DOIs
Publication statusPublished - Jul 2022

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