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Fundaun J, Kolski M, Baskozos G, Dilley A, Sterling M, Schmid AB. Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis. Pain 2022; 163:e789-e811. [PMID: 35050963 PMCID: PMC7612893 DOI: 10.1097/j.pain.0000000000002509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is no clear understanding of the mechanisms causing persistent pain in patients with whiplash-associated disorder (WAD). The aim of this systematic review was to assess the evidence for nerve pathology and neuropathic pain in patients with WAD. EMBASE, PubMed, CINAHL (EBSCO), and MEDLINE were searched from inception to September 1, 2020. Study quality and risk of bias were assessed using the Newcastle-Ottawa Quality Assessment Scales. Fifty-four studies reporting on 390,644 patients and 918 controls were included. Clinical questionnaires suggested symptoms of predominant neuropathic characteristic in 34% of patients (range 25%-75%). The mean prevalence of nerve pathology detected with neurological examination was 13% (0%-100%) and 32% (10%-100%) with electrodiagnostic testing. Patients independent of WAD severity (Quebec Task Force grades I-IV) demonstrated significantly impaired sensory detection thresholds of the index finger compared with controls, including mechanical (SMD 0.65 [0.30; 1.00] P < 0.005), current (SMD 0.82 [0.25; 1.39] P = 0.0165), cold (SMD -0.43 [-0.73; -0.13] P = 0.0204), and warm detection (SMD 0.84 [0.25; 1.42] P = 0.0200). Patients with WAD had significantly heightened nerve mechanosensitivity compared with controls on median nerve pressure pain thresholds (SMD -1.10 [-1.50; -0.70], P < 0.0001) and neurodynamic tests (SMD 1.68 [0.92; 2.44], P = 0.0004). Similar sensory dysfunction and nerve mechanosensitivity was seen in WAD grade II, which contradicts its traditional definition of absent nerve involvement. Our findings strongly suggest a subset of patients with WAD demonstrate signs of peripheral nerve pathology and neuropathic pain. Although there was heterogeneity among some studies, typical WAD classifications may need to be reconsidered and include detailed clinical assessments for nerve integrity.
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Affiliation(s)
- Joel Fundaun
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| | - Melissa Kolski
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Musculoskeletal Outpatient Department, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Georgios Baskozos
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| | - Andrew Dilley
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
| | - Annina B Schmid
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
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Kim S, Kyeong DH, Kim MK, Kim CY, Lee YJ, Lee J, Ha IH, Park KS. The efficacy and safety of non-resistance manual therapy in inpatients with acute neck pain caused by traffic accidents: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e29151. [PMID: 35665724 PMCID: PMC9276176 DOI: 10.1097/md.0000000000029151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Neck pain and functional impairment are common complications of traffic accidents (TAs); however, the effects of manual therapy on these symptoms have rarely been studied in the literature. Thus, this randomized controlled trial aims to assess the effectiveness and safety of non-resistance manual therapy (NRT)-a treatment combining mobilization and pressure release techniques-on acute neck pain caused by TA. METHOD This study will use a two-armed, parallel, assessor-blinded randomized controlled trial design and will be conducted in the Daejeon Jaseng Hospital of Korean Medicine in South Korea. One hundred twenty patients will be recruited and randomized into an integrative Korean medicine treatment (IMKT) + NRT group and IMKT group in a 1:1 ratio. The primary outcome is a change in the numeric rating scale for neck pain immediately after treatment on hospital day 5 compared to those at baseline. The secondary outcomes are numeric rating scale for radiating arm pain, visual analogue scale for neck pain and radiating arm pain, cervical active range of motion, neck disability index, Patient Global Impression of Change, Short Form-12 Health Survey, and Posttraumatic Stress Disorder Checklist for DSM-5. DISCUSSION The findings of this study on the effectiveness and safety of NRT will be helpful for patients with TA-induced neck pain in clinical practice and will provide evidence for developing relevant healthcare-related policies. TRIAL REGISTRATION This protocol has been registered at Clinicaltrials.gov (NCT04660175).
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Affiliation(s)
- Suna Kim
- Daejeon Jaseng Hospital of Korean Medicine, Seo-gu, Daejeon, Republic of Korea
| | - Da-Hyun Kyeong
- Daejeon Jaseng Hospital of Korean Medicine, Seo-gu, Daejeon, Republic of Korea
| | - Min-Kyung Kim
- Daejeon Jaseng Hospital of Korean Medicine, Seo-gu, Daejeon, Republic of Korea
| | - Chang-Yeon Kim
- Daejeon Jaseng Hospital of Korean Medicine, Seo-gu, Daejeon, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Seoul, Republic of Korea
| | - Jinho Lee
- Jaseng Hospital of Korean Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Seoul, Republic of Korea
| | - Kyoung Sun Park
- Jaseng Hospital of Korean Medicine, Gangnam-gu, Seoul, Republic of Korea
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Malik K, Eseonu KC, Pang D, Fakouri B, Panchmatia JR. Is Preexisting Cervical Degeneration a Risk Factor for Poor Prognosis in Whiplash-Associated Disorder? Int J Spine Surg 2021; 15:710-717. [PMID: 34281955 PMCID: PMC8375694 DOI: 10.14444/8093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The term whiplash describes the acceleration-deceleration mechanism of injury to the cervical spine. Whiplash injuries present with a variety of clinical and psychological manifestations, collectively termed as whiplash-associated disorders (WADs). Although largely self-limiting, some patients may experience long-lasting symptoms. This review aimed to summarize the current literature regarding the predictive value of cervical degeneration in the prognosis of patients with WAD. METHODS A comprehensive search of the literature was performed. Nine studies were identified, including 894 patients, with an age range between 16 and 76 years. RESULTS A statistically significant association was found between moderate facet joint degeneration and nonrecovery. Although no association was established between isolated disc degeneration and nonrecovery, total cervical degeneration (facet joint + disc degeneration) was shown to correlate with nonrecovery.All included studies demonstrated the lack of correlation between preexisting disc degeneration and clinical outcomes. Four studies showed a significant correlation between cervical degeneration and poor prognosis following whiplash injury. A significantly higher proportion of patients who remained symptomatic at 2 years following a whiplash injury had preexisting degenerative changes. CONCLUSIONS This review highlights the presence of significant variability in the existing literature concerning WAD in terms of study methodology, definitions of cervical degeneration, and outcome measures. Degenerative changes of the facet joint lead to alterations in its biomechanics. Several cadaveric, biomechanical, and clinical studies have demonstrated facet joints as a source of pain in patients with chronic WAD. We present moderate evidence to suggest that preexisting facet joint degeneration is a negative prognostic indicator for long-lasting symptoms in WAD. Conversely, preexisting disc degeneration is not associated with chronicity of WAD symptoms. We propose facet joint instability due to facet joint capsule rupture as a potential mechanism for nonrecovery. Further studies are needed to inform our knowledge of the long-term sequelae of WAD among patients with preexisting cervicalspine degeneration.
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Affiliation(s)
- Khalid Malik
- Speciality Registrar, Trauma and Orthopaedics, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - K. C. Eseonu
- Senior Spinal Fellow, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - D. Pang
- Consultant Pain Physician, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - B. Fakouri
- Consultant Spine Surgeon and Lead for Spine Surgery, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - J. R. Panchmatia
- Consultant Spine Surgeon, Guy's & St. Thomas' Hospitals, London, United Kingdom
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Sewell J, Dixon C, Morris R, Stuart S. Anatomical distribution of musculoskeletal disorders following a road traffic collision in litigants presenting to physiotherapists within a private-clinic in North-East England. Physiother Theory Pract 2018; 35:873-883. [PMID: 29659312 DOI: 10.1080/09593985.2018.1459986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Introduction: Musculoskeletal disorders (MSDs) are common following a road traffic collision (RTC) in England. Establishing the anatomical distribution of MSDs following RTC that present to physiotherapists may improve understanding and clinical practice. This study examined anatomical distribution of MSDs that present to physiotherapists within a litigant population following a RTC in England. Methods: A retrospective review of physiotherapy records was conducted at a private practice in North-East England. Data were collected from 2105 patients between January 2014 and December 2015. The primary outcome was anatomical regions with MSDs. Descriptive data is reported. Results: Overall, 90% of patients presented with a neck/upper back disorder, while 52% presented with a lower back disorder. Of the assessed patients, 46% presented with one MSD, 45% presented with two MSDs while 9% presented with ≥3 MSDs. Further analysis showed that those who presented to physiotherapy later and were not motor vehicle occupants (MVOs) were more likely to have upper-limb, lower-limb, or lumbar MSDs. Younger patients, who presented sooner and were non-MVO were more likely to have multiple regions affected by MSDs. Conclusions: This study presents epidemiological evidence that MSDs following a RTC occur primarily in the neck/upper back or lower back regions, and that multiple MSDs are common.
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Affiliation(s)
| | - Cheryl Dixon
- a On Medical Ltd ., Newcastle upon Tyne , England, UK
| | - Rosie Morris
- a On Medical Ltd ., Newcastle upon Tyne , England, UK.,b Institute of Neuroscience/Newcastle University Institute of Ageing , Newcastle University , Newcastle upon Tyne , England, UK
| | - Samuel Stuart
- a On Medical Ltd ., Newcastle upon Tyne , England, UK.,b Institute of Neuroscience/Newcastle University Institute of Ageing , Newcastle University , Newcastle upon Tyne , England, UK
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Wiangkham T, Duda J, Haque MS, Rushton A. Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study. BMJ Open 2016; 6:e011764. [PMID: 27630069 PMCID: PMC5030579 DOI: 10.1136/bmjopen-2016-011764] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop an active behavioural physiotherapy intervention (ABPI) for managing acute whiplash-associated disorder (WAD) II using a modified Delphi method to develop consensus for the basic features of the ABPI. DESIGN Modified Delphi study. Our systematic review and meta-analysis evaluating conservative management for acute WADII found that a combined ABPI may be a useful intervention to prevent patients progressing to chronicity. No previous research has considered a combined behavioural approach and active physiotherapy in the management of acute WADII patients. The ABPI was therefore developed using a rigorous consensus method using international research and local clinical whiplash experts. Descriptive statistics were used to assess consensus in each round. SETTING Online international survey. PARTICIPANTS A purposive sample of 97 potential participants (aiming to recruit n=30) consisting of international research whiplash experts, UK private physiotherapists and UK postgraduate musculoskeletal physiotherapy students were invited to participate via electronic mail with an attached participant information sheet and consent form. RESULTS 36 individuals signed and returned the consent form. In round 1, 32/36 participants (response rate=89%, mean age±SD=36.03±13.22 years) across 8 countries (Australia, Finland, Greece, India, Netherlands, Norway, Sweden and UK) contributed to round 1 questionnaire. Response rates were 78% and 75% for rounds 2 and 3, respectively. Following round 3, 12 underlying principles (eg, return to normal function as soon as possible, pain management, encouragement of self-management, reduce fear avoidance and anxiety) achieved consensus. The treatment components reaching consensus included behavioural (eg, education, reassurance, self-management) and physiotherapy components (eg, exercises for stability and mobility). No passive intervention achieved consensus. CONCLUSIONS Experts suggested and agreed the underlying principles and treatment components of the ABPI for the management of acute WADII. The ABPI was underpinned by social cognitive theory focusing on self-efficacy enhancement prior to conducting a phase II trial.
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Affiliation(s)
- Taweewat Wiangkham
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - M Sayeed Haque
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Heneghan NR, Smith R, Rushton A. Thoracic dysfunction in whiplash-associated disorders: a systematic review and meta-analysis protocol. Syst Rev 2016; 5:26. [PMID: 26860082 PMCID: PMC4748634 DOI: 10.1186/s13643-016-0201-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/03/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Whiplash-associated disorder (WAD) research has largely focused on the neck, yet symptoms often include other areas. The prevalence of acute thoracic spine pain is reported ~66 %, which is perhaps unsurprising given the mechanism of injury involves a forceful loading/eccentric contraction of posterior thoracic structures such as the trapezius. Many individuals with WAD experience disability and pain beyond normal tissue healing time, termed chronic WAD. With the thoracic spine contributing to neck mobility, and 23 % of individuals complaining of thoracic pain 1 year post injury, it is time to look beyond the neck to fully understand the anatomical dysfunction in WAD. METHODS/DESIGN A systematic review protocol has been designed and will be reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). A sensitive topic-based search strategy is planned from inception to the current date. Databases, grey literature and registers will be searched using terms and keywords derived from a scoping search. Two reviewers will independently search information sources, assess studies for inclusion and extract data. A third reviewer will check for accuracy. Data to be extracted include summary data: sample size and characteristics, timescales to reflect disorder state, patient-reported or performance-based measure and findings. Risk of bias within studies will be assessed using the Newcastle-Ottawa Scale. Quantitative meta-analysis approach will be used for homogenous data and where appropriate presented using subgroups. All other results will be presented using narrative summaries. Subgroups will, where possible, be based on patient-reported or performance-based measure of dysfunction and/or stage of condition (acute/sub-acute or chronic). Strength of the overall body of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). DISCUSSION This is the first study to bring together evidence of thoracic dysfunction post whiplash and provide new insights into the scope and nature of thoracic dysfunction in WAD. With current management options being largely focused to a primary neck complaint and many patients going to become chronic in their presentations, this review may stimulate research and clinical interest in a largely under investigated, yet anatomically and kinematically related, spinal region. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015026983.
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Affiliation(s)
- Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Richard Smith
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Ehrenborg C, Gustafsson S, Archenholtz B. Long-term effect in ADL after an interdisciplinary rehabilitation programme for WAD patients: a mixed-method study for deeper understanding of participants' programme experiences. Disabil Rehabil 2013; 36:1006-13. [PMID: 23962189 DOI: 10.3109/09638288.2013.825651] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate long-term effects in self-perceived occupational performance and satisfaction in Activities of Daily Living (ADL) for patients with Whiplash Associated Disorders (WAD) with chronic pain in an interdisciplinary rehabilitation programme, and investigate patients' opinions of programme effects. METHOD A mixed-method with sequential explanatory design was used. Fifty-three patients with WAD were followed-up 12 months after discharge. The Canadian Occupational Performance Measure was used to evaluate the change in ADL and the Multidimensional Pain Inventory for psychosocial functioning. Telephone interviews, based on five structured questions about the perceived impact of the rehabilitation programme, were made. RESULTS The 12-month follow-up showed significant ADL improvement (p < 0.001). There was less interference in daily activities due to pain (p < 0.01), and life control increased. More people were back to work. Interviews revealed the programme's environment as strengthening and safe, and participants felt they were met with respect. Key success factors were to be treated with respect to being part of the social context and to obtain new knowledge. CONCLUSIONS The interdisciplinary rehabilitation programme had initiated a process of change towards a more active life for the participants. They had found a new way of managing their lives. Despite the absence of pain reduction, they managed ADL in a better way, had more life control and returned to work to a higher degree. IMPLICATIONS FOR REHABILITATION Chronic pain after WAD effects the entire life for many people. Long-term effects on activities of daily living, life control and work ability have shown positive results after an interdisciplinary rehabilitation programme based on behavioural and cognitive principles. The key success factors were to be treated with respect to being a part of a social context and to obtain new knowledge.
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Affiliation(s)
- Cecilia Ehrenborg
- Department Occupational Therapy, Rehabilitation Clinic , Södra Älvsborgs Hospital, Borås , Sweden
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