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Michele Sterling - One of the best experts on this subject based on the ideXlab platform.
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spinal cord injury is not a feature of chronic Whiplash Associated Disorder a magnetic resonance spectroscopy study
European Spine Journal, 2020Co-Authors: Michele Sterling, Scott F Farrell, Gary Cowin, Ashley Pedler, Gail DurbridgeAbstract:Purpose: Injury to the cervical spinal cord has been suggested as a mechanism that may underpin chronic Whiplash-Associated Disorder (WAD). This study aimed to assess metabolite concentrations indicative of neuronal injury or pathology in the cervical cord in people with chronic WAD. Methods: Forty-one people with chronic WAD (mean [SD] age 39.6 [11.0] years, 25 females) and 14 healthy controls (39.2 [12.6] years, 9 females) underwent cervical spinal cord magnetic resonance spectroscopy to measure the metabolites N-acetylaspartate (NAA), creatine (Cr) and choline (Cho). Participants with WAD completed clinical questionnaires on pain intensity (Visual Analogue Scale), disability (Neck Disability Index) and psychological factors (Pain Catastrophising Scale, Post-traumatic Diagnostic Scale), and underwent cervical range of motion assessment and pain threshold testing to cold and pressure stimuli. Data were analysed using hypothesis testing and Spearman correlations (p < 0.05). Results: There were no differences between the WAD and control groups for NAA/Cr (median [IQR] WAD 1.73 [1.38, 1.97], controls 2.09 [1.28, 2.89], p = 0.37), NAA/Cho (WAD 1.50 [1.18, 2.01], controls 1.57 [1.26, 1.93], p = 0.91) or Cr/Cho (WAD 0.84 [0.64, 1.17], controls 0.76 [0.60, 0.91], p = 0.33). There were no significant correlations between NAA/Cr, NAA/Cho or Cr/Cho and any clinical variable (p ≥ 0.06). Conclusions: Findings are consistent with major metabolic changes not being present in chronic WAD.
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attachment insecurity as a vulnerability factor in the development of chronic Whiplash Associated Disorder a prospective cohort study
Journal of Psychosomatic Research, 2019Co-Authors: Tonny Elmose Andersen, Michele Sterling, Annick Maujean, Pamela MeredithAbstract:Objectives: Attachment theory represents a dynamic model for understanding how pre-existing personality factors may contribute to the development of chronic pain and disability after Whiplash injury. The aim of the present study was to investigate the impact of attachment insecurity on disability 6-months post-injury. It was hypothesized that: (1) levels of attachment insecurity assessed at baseline would predict levels of disability six months post-injury, and (2) both attachment dimensions (anxiety and avoidance) would moderate associations between pain and disability, and psychological distress and disability. Methods: Questionnaire data were collected consecutively from a 1-year cohort of Whiplash-injured. Data were collected from the emergency room within 1-month post-injury and at follow up 6-months post-injury (n = 205). Results: Both attachment dimensions were significantly Associated with physical and psychosocial disability. Moreover, when attachment avoidance and attachment axiety were at the mean value (0SD) and high (+1SD), there was a significant positive relationship between pain intensity and disability (physical and psychosocial), with the exception of attachment anxiety, that only moderated the association between pain intensity and psychosocial disability when high. Also, when attachment avoidance and attachment axiety were high there was a significant positive relationship between depression and disability. Finally, when attachment avoidance was at the mean level and high there was a significant positive relationship between pain-catastrophizing and psychosocial disability. Conclusion: Although the effects sizes for the moderations were small, the results support claims that attachment insecurity, measurable before onset of injury, represents a valuable pre-trauma vulnerability for less optimal recovery after Whiplash injury.
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lateral atlantoaxial joint meniscoid volume in individuals with Whiplash Associated Disorder a case control study
Musculoskeletal science and practice, 2018Co-Authors: Michele Sterling, Scott F Farrell, Subaat Khan, Peter G Osmotherly, Jon Cornwall, Darren A RivettAbstract:Abstract Background Lateral atlantoaxial (LAA) joints are established sources of nociceptive input in chronic Whiplash Associated Disorder (WAD). These joints contain intra-articular meniscoids that may be damaged in Whiplash trauma. LAA joint meniscoid morphology has not been investigated comprehensively in a chronic WAD population, and it is unclear whether morphological differences exist compared to a pain-free population. Objectives This study examined LAA joint meniscoid volume in individuals with chronic WAD who report pain in a distribution consistent with LAA joint pain. Design Case-control study. Method Fourteen individuals with chronic WAD with pain in an LAA joint distribution (mean [SD] age 38.1 [10.8] years; six female) and 14 age- and sex-matched pain-free controls (38.0 [10.5] years) underwent cervical spine magnetic resonance imaging. LAA joint images were inspected for meniscoids; meniscoid volume was calculated in mm 3 and as a percentage of articular cavity volume. Symptom duration, location and intensity were recorded. Data were analysed using paired t-tests, Wilcoxon signed-rank testing, Spearman's rank testing, linear and logistic regression (α Results Ventral and dorsal meniscoids (n = 112) were found in each LAA joint. Greater dorsal meniscoid volume as a percentage of articular cavity volume was Associated with higher pain intensity (odds ratio 1.48, p = 0.03; likelihood ratio test chi-square 2 = 6.64, p = 0.04), however no significant differences existed between meniscoid volumes of WAD and control participants. Conclusions Findings indicate a potential link between dorsal LAA joint meniscoid volume and pain, suggesting larger meniscoid size may have pathoanatomical significance in WAD.
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post traumatic stress symptom clusters in acute Whiplash Associated Disorder and their prediction of chronic pain related disability
Pain reports (Baltimore Md.), 2017Co-Authors: Annick Maujean, Tonny Elmose Andersen, Matthew J Gullo, Sophie Lykkegaard Ravn, Michele SterlingAbstract:The presence of post-traumatic stress Disorder (PTSD) symptoms has been found to be Associated with an increased risk of persisting neck pain and disability in motor vehicle crash (MVC) survivors with Whiplash injuries. The findings are mixed as to which PTSD symptom(s) best predicts recovery in this population. The aims were (1) to explore the factor structure of the Post-traumatic Stress Diagnostic Scale (PDS) in a sample of acute Whiplash-injured individuals following a MVC and (2) to identify the PTSD-symptom clusters that best predict long-term neck pain-related disability in this population as measured by the Neck Pain Disability Index (NDI). A sample (N = 146) of Whiplash-injured individuals completed the NDI and the PDS at baseline ( Principal component analyses generated 2 symptom clusters: re-experiencing/avoidance and hyperarousal/numbing. Nine trauma-related PTSD symptoms loaded exclusively on the re-experiencing/avoidance cluster and 7 nonspecific PTSD symptoms loaded exclusively on the hyperarousal/numbing cluster. One PTSD symptom (ie, inability to recall an important aspect of the trauma) had no salient loading on either clusters. Structural equation modelling analysis indicated that there was a significant positive relationship between the hyperarousal/numbing symptom cluster and long-term neck pain-related disability, while no significant relationship was found between the re-experiencing/avoidance symptom cluster and long-term neck pain-related disability. Given that only the hyperarousal/numbing symptom cluster predicted long-term neck pain-related disability, this finding may have implications in terms of diagnosis, assessment, and management of the psychological impact of Whiplash-injured individuals following a MVC.
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Post-traumatic stress symptom clusters in acute Whiplash Associated Disorder and their prediction of chronic pain-related disability
Wolters Kluwer, 2017Co-Authors: Annick Maujean, Tonny Elmose Andersen, Matthew J Gullo, Sophie Lykkegaard Ravn, Michele SterlingAbstract:Abstract. Introduction:. The presence of post-traumatic stress Disorder (PTSD) symptoms has been found to be Associated with an increased risk of persisting neck pain and disability in motor vehicle crash (MVC) survivors with Whiplash injuries. The findings are mixed as to which PTSD symptom(s) best predicts recovery in this population. Objectives:. The aims were (1) to explore the factor structure of the Post-traumatic Stress Diagnostic Scale (PDS) in a sample of acute Whiplash-injured individuals following a MVC and (2) to identify the PTSD-symptom clusters that best predict long-term neck pain-related disability in this population as measured by the Neck Pain Disability Index (NDI). Methods:. A sample (N = 146) of Whiplash-injured individuals completed the NDI and the PDS at baseline (
Sterling Michele - One of the best experts on this subject based on the ideXlab platform.
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Medical and allied health service use during acute and chronic post-injury periods in Whiplash injured individuals
'Springer Science and Business Media LLC', 2020Co-Authors: Ritchie Carrie, Smith Ashley, Sterling MicheleAbstract:Background: Individuals with Whiplash Associated Disorder (WAD) frequently experience neck pain in addition to other physical, psychological and social symptoms. Consequently, treatment is sought from a variety of health professionals. The limited data available about health services use in this population are conflicting. This study aimed to characterise health service use in individuals with WAD from a motor vehicle crash. Methods: Medical (general practitioner (GP), medical specialist, emergency services (ED), radiology - x-ray, computed tomography, magnetic resonance imaging, ultrasound) and allied health service (physiotherapy, chiropractor, psychologist, osteopath, occupational therapy) use during acute (< 12 weeks) and chronic (12 weeks to 2 years) post-injury periods were analysed in adults claiming compensation for WAD in the no-fault jurisdiction of Victoria, Australia (n = 37,315). Results: Most WAD claimants had an acute post-injury health service payment (95%, n = 35,348), and approximately one-third (29%, n = 10,871) had a chronic post-injury health service payment. During an acute post-injury period, the most frequently compensated services were for: ED (82% of acute claimants), radiology (56%), and medical specialist (38%). Whereas, physiotherapy (64.4% of chronic claimants), GP (48.1%), and radiology (34.6%) were the most frequently paid services during the chronic period. Females received significantly more payments from physiotherapists (F = 23.4%, M = 18%, z = - 11.3,
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Small fibre pathology in chronic Whiplash-Associated Disorder: a cross-sectional study
'Wiley', 2020Co-Authors: Farrell, Scott F., Sterling Michele, Irving-rodgers Helen, Schmid, Annina B.Abstract:Background: Mechanisms underpinning ongoing symptoms in chronic Whiplash Associated‐Disorder (WAD) are not well understood. People with chronic WAD can exhibit sensory dysfunction consistent with small nerve fibre pathology, including thermal hypoaesthesia and hyperalgesia. This study investigated small fibre structure and function in chronic WAD. Methods: Twenty‐four people with chronic WAD (median [IQR] age 49 [15] years, 16 females) and 24 pain‐free controls (50 [17] years, 16 females) were recruited. Intraepidermal nerve fibre density (IENFD) and dermal innervation were assessed by skin biopsy. This was performed at (a) the lateral index finger on the primary side of pain and (b) superior to the lateral malleolus on the contralateral side. Quantitative sensory testing was performed over the hand. Results: The WAD group exhibited lower IENFD at the finger (WAD: median [IQR] 4.5 [4.9] fibres/mm; control 7.3 [3.9]; p = .010), but not the ankle (WAD: mean [SD] 7.3 [3.7] fibres/mm; control 9.3 [3.8]; p = .09). Dermal innervation was lower in the WAD group at the finger (WAD: median [IQR] 3.7 [2.8] nerve bundles/mm2; controls: 4.9 [2.1]; p = .017) but not the ankle (WAD: median [IQR] 2.1 [1.9] nerve bundles/mm2; controls: 1.8 [1.8]; p = .70). In the WAD group, hand thermal and light touch detection were impaired, and heat pain thresholds were lowered (p ≤ .037). Conclusions: Findings suggest small fibre structural and functional deficits in chronic WAD, implicating potential involvement of small fibre pathology. Significance: Our study found decreased intraepidermal nerve fibre density, reduced dermal innervation, thermal hypoaesthesia and hypersensitivity in people with chronic WAD, suggestive of small fibre pathology. This observation of peripheral nervous system pathology in chronic Whiplash provides novel insights on mechanisms underpinning symptoms and challenges commonly held beliefs regarding this condition
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Magnetic resonance spectroscopy assessment of brain metabolite concentrations in individuals with chronic Whiplash Associated Disorder: a cross-sectional study
'Ovid Technologies (Wolters Kluwer Health)', 2020Co-Authors: Farrell, Scott F., Cowin, Gary J., Pedler Ashley, Durbridge Gail, De Zoete, Rutger M. J., Sterling MicheleAbstract:Pathophysiologic mechanisms underpinning ongoing pain in Whiplash Associated Disorder (WAD) are not well understood, however alterations in brain morphology and function have been observed in this population, as well as in other chronic pain conditions. This study investigated metabolite profiles of brain regions in people with chronic WAD compared with controls.Thirty-eight patients with chronic WAD (mean [SD] age 39.5 [11.3] years, 23 female) and 16 pain-free controls (38.9 [12.7] years, 11 female) underwent multi-voxel brain magnetic resonance spectroscopy. At the anterior cingulate cortex (ACC), primary motor cortex (1MC) and somatosensory cortex (SSC), ratios of metabolite concentrations were calculated for N-acetylaspartate (NAA), creatine (Cr), choline (Cho), myo-inositol (Ins) and glutamate/glutamine (Glx). Chronic WAD group participants completed clinical questionnaires as well as cold and pressure pain threshold assessment. Data were analysed with hypothesis testing and Spearman correlations (P≥0.05), with Benjamini-Hochberg corrections (5% false discovery rate).No group differences were observed for NAA:Cr, NAA:Cho, Cr:Cho, Glx:NAA, Glx:Cr, Glx:Cho, Ins:NAA, Ins:Cr, Ins:Cho or Ins:Glx for left or right ACC, 1MC or SSC following correction for multiple comparisons. No significant correlations were observed between metabolite ratios and any clinical variable.These results suggest that ongoing pain and disability in this population may not be underpinned by metabolite aberrations in the brain regions examined. Further research is required to progress our understanding of cortical contributions to neurophysiologic mechanisms in chronic WAD
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Attachment insecurity as a vulnerability factor in the development of chronic Whiplash Associated Disorder – a prospective cohort study
'Elsevier BV', 2019Co-Authors: Andersen, Tonny Elmose, Sterling Michele, Maujean Annick, Meredith PamelaAbstract:Objectives: Attachment theory represents a dynamic model for understanding how pre-existing personality factors may contribute to the development of chronic pain and disability after Whiplash injury. The aim of the present study was to investigate the impact of attachment insecurity on disability 6-months post-injury. It was hypothesized that: (1) levels of attachment insecurity assessed at baseline would predict levels of disability six months post-injury, and (2) both attachment dimensions (anxiety and avoidance) would moderate associations between pain and disability, and psychological distress and disability. Methods: Questionnaire data were collected consecutively from a 1-year cohort of Whiplash-injured. Data were collected from the emergency room within 1-month post-injury and at follow up 6-months post-injury (n = 205). Results: Both attachment dimensions were significantly Associated with physical and psychosocial disability. Moreover, when attachment avoidance and attachment axiety were at the mean value (0SD) and high (+1SD), there was a significant positive relationship between pain intensity and disability (physical and psychosocial), with the exception of attachment anxiety, that only moderated the association between pain intensity and psychosocial disability when high. Also, when attachment avoidance and attachment axiety were high there was a significant positive relationship between depression and disability. Finally, when attachment avoidance was at the mean level and high there was a significant positive relationship between pain-catastrophizing and psychosocial disability. Conclusion: Although the effects sizes for the moderations were small, the results support claims that attachment insecurity, measurable before onset of injury, represents a valuable pre-trauma vulnerability for less optimal recovery after Whiplash injury
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Attachment insecurity as a vulnerability factor in the development of chronic Whiplash Associated Disorder – A prospective cohort study
'Elsevier BV', 2019Co-Authors: Andersen, Tonny E, Sterling Michele, Maujean Annick, Meredith, Pamela JAbstract:Meredith, PJ ORCiD: 0000-0002-2981-9189Objectives: Attachment theory represents a dynamic model for understanding how pre-existing personality factors may contribute to the development of chronic pain and disability after Whiplash injury. The aim of the present study was to investigate the impact of attachment insecurity on disability 6-months post-injury. It was hypothesized that: (1) levels of attachment insecurity assessed at baseline would predict levels of disability six months post-injury, and (2) both attachment dimensions (anxiety and avoidance) would moderate associations between pain and disability, and psychological distress and disability. Methods: Questionnaire data were collected consecutively from a 1-year cohort of Whiplash-injured. Data were collected from the emergency room within 1-month post-injury and at follow up 6-months post-injury (n = 205). Results: Both attachment dimensions were significantly Associated with physical and psychosocial disability. Moreover, when attachment avoidance and attachment axiety were at the mean value (0SD) and high (+1SD), there was a significant positive relationship between pain intensity and disability (physical and psychosocial), with the exception of attachment anxiety, that only moderated the association between pain intensity and psychosocial disability when high. Also, when attachment avoidance and attachment axiety were high there was a significant positive relationship between depression and disability. Finally, when attachment avoidance was at the mean level and high there was a significant positive relationship between pain-catastrophizing and psychosocial disability. Conclusion: Although the effects sizes for the moderations were small, the results support claims that attachment insecurity, measurable before onset of injury, represents a valuable pre-trauma vulnerability for less optimal recovery after Whiplash injury
Peolsson Anneli - One of the best experts on this subject based on the ideXlab platform.
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CHANGES IN DORSAL NECK MUSCLE FUNCTION IN INDIVIDUALS WITH CHRONIC Whiplash-Associated DisorderS: A REAL-TIME ULTRASOUND CASE-CONTROL STUDY
'Elsevier BV', 2016Co-Authors: Peterson Gunnel, Dedering Asa, Nilsson David, Trygg Johan, Wallman Thorne, Peterson Simon, Peolsson AnneliAbstract:Impaired neck muscle function leads to disability in individuals with chronic Whiplash-Associated Disorder (WAD), but diagnostic tools are lacking. In this study, deformations and deformation rates were investigated in five dorsal neck muscles during 10 arm elevations by ultrasonography with speckle tracking analyses. Forty individuals with chronic WAD (28 women and 12 men, mean age = 37 y) and 40 healthy controls matched for age and sex were included. The WAD group had higher deformation rates in the multifidus muscle during the first (p < 0.04) and 10th (only women, p < 0.01) arm elevations compared with the control group. Linear relationships between the neck muscles for deformation rate (controls: R-2 = 0.24-0.82, WAD: R-2 = 0.05-0.74) and deformation of the deepest muscles (controls: R-2 = 0.61-0.32, WAD: R-2 = 0.15-0.01) were stronger for women in the control group versus women with WAD, indicating there is altered interplay between dorsal neck muscles in chronic WAD. (C) 2016 World Federation for Ultrasound in Medicine & Biology.Funding Agencies|Swedish government; Swedish Social Insurance Agency through the REHSAM Foundation [RS2010/009]; Swedish Research Council; Centre for Clinical Research Sormland at Uppsala University Sweden; Uppsala-Orebro Regional Research Council Sweden
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Effects of Neck-Specific Exercises Compared to Waiting List for Individuals With Chronic Whiplash-Associated Disorders: A Prospective, Randomized Controlled Study
'Elsevier BV', 2016Co-Authors: Peolsson Anneli, Landén Ludvigsson Maria, Tigerfors Ann-marie, Peterson GunnelAbstract:Objective: To determine whether 3 months of neck-specific exercises (NSEs) could benefit individuals with chronic Whiplash-Associated Disorder (WAD) who were on a waiting list (WL) for treatment. Design: A prospective, randomized controlled study. Setting: Primary health care. Participants: Individuals (N=41; 31 women, 10 men; mean age +/- SD, 38 +/- 11.2y) with chronic (6-36mo) WAD, grades 2 and 3, were analyzed. Interventions: Patients were randomly assigned to NSEs or no treatment for 3 months. Main Outcome Measures: Neck-specific disability (Neck Disability Index [NDI]), neck pain (visual analog scale), general pain-related disability (Pain Disability Index [PDI]), self-perceived performance ability (Self-Efficacy Scale [SES]), and health-related quality of life (EuroQol 5 dimensions [EQ-5D]) were measured. Results: NSEs significantly improved the NDI, SES, and EQ-5D compared with WL (P<.01). There was significant improvement (P<.0001) over time in all outcomes for NSEs, and apart from the PDI, significant worsening (P=.002-.0002) over time for the untreated group. Conclusions: NSEs were more beneficial than no intervention while on a WL for individuals with chronic WAD. (C) 2016 by the American Congress of Rehabilitation Medicin
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Altered ventral neck muscle deformation for individuals with Whiplash Associated Disorder compared to healthy controls : A case-control ultrasound study
'Elsevier BV', 2015Co-Authors: Peterson Gunnel, Dedering Asa, Andersson Erika, Nilsson David, Trygg Johan, Peolsson Michael, Wallman Thorne, Peolsson AnneliAbstract:Previous studies have shown altered neck muscle function in individuals with chronic Whiplash Associated Disorder (WAD). However, we lack real-time investigations with non-invasive methods that can distinguish between the different ventral neck muscle layers. This study investigated deformations and deformation rates in the sternocleidomastoid (SCM), longus capitis (Lcap), and longus colli (Lco) muscles with real-time ultrasonography. Twenty-six individuals with WAD were compared with 26 controls, matched for age and sex. Ultrasound imaging of the SCM, Lcap, and Lco were recorded during 10 repetitive arm elevations. The first and tenth arm elevations were post-process analyzed with speckle tracking. There were few significant differences in the deformations or deformation rates in the SCM, Lcap, and Lco between the WAD and control group. In controls, deformations and deformation rates showed linear positive relationships between SCM/Lcap, SCM/Lco, and Lcap/Lco which increased from the first arm elevation (R(2) = 0.14-0.70); to the tenth arm elevation (R(2) = 0.51-0.71). The WAD group showed similar or weaker linear relationship (R(2) < 0.19) during the tenth compared to the first (R(2) < 0.44) arm elevation except for deformations in Lcap/Lco (R(2) = 0.13-0.57). This result indicated that deformations and deformation rates in one muscle were correlated by similar deformations and deformation rates in other neck muscles in the control group, but this interplay between muscles was not found in the WAD group
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Factors Associated with work ability in patients with chronic Whiplash-Associated Disorder grade II-III: a cross-sectional analysis
'Acta Dermato-Venereologica', 2015Co-Authors: Agnew Louise, Peterson Gunnel, Johnston Venerina, Ludvigsson, Maria Landén, Overmeer Thomas, Johansson Gun, Peolsson AnneliAbstract:Objective: To investigate the factors related to self-perceived work ability in patients with chronic Whiplash-Associated Disorder grades II-III. Design: Cross-sectional analysis. Patients: A total of 166 working age patients with chronic Whiplash-Associated Disorder. Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability. Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R2= 0.65, p < 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress. Conclusion: Condition-specific and psychosocial factors are Associated with self-perceived work ability of individuals with chronic Whiplash-Associated Disorder
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FACTORS Associated WITH WORK ABILITY IN PATIENTS WITH CHRONIC Whiplash-Associated Disorder GRADE II-III: A CROSS-SECTIONAL ANALYSIS
'Acta Dermato-Venereologica', 2015Co-Authors: Agnew Louise, Peterson Gunnel, Johnston Venerina, Overmeer Thomas, Johansson Gun, Landén Ludvigsson Maria, Peolsson AnneliAbstract:Objective: To investigate the factors related to self-perceived work ability in patients with chronic Whiplash-Associated Disorder grades II-III. Design: Cross-sectional analysis. Patients: A total of 166 working age patients with chronic Whiplash-Associated Disorder. Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability. Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R-2 = 0.65, p less than 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress. Conclusion: Condition-specific and psychosocial factors are Associated with self-perceived work ability of individuals with chronic Whiplash-Associated Disorder.Funding Agencies|Swedish government; Swedish Social Insurance Agency through the REHSAM Foundation
Scott F Farrell - One of the best experts on this subject based on the ideXlab platform.
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spinal cord injury is not a feature of chronic Whiplash Associated Disorder a magnetic resonance spectroscopy study
European Spine Journal, 2020Co-Authors: Michele Sterling, Scott F Farrell, Gary Cowin, Ashley Pedler, Gail DurbridgeAbstract:Purpose: Injury to the cervical spinal cord has been suggested as a mechanism that may underpin chronic Whiplash-Associated Disorder (WAD). This study aimed to assess metabolite concentrations indicative of neuronal injury or pathology in the cervical cord in people with chronic WAD. Methods: Forty-one people with chronic WAD (mean [SD] age 39.6 [11.0] years, 25 females) and 14 healthy controls (39.2 [12.6] years, 9 females) underwent cervical spinal cord magnetic resonance spectroscopy to measure the metabolites N-acetylaspartate (NAA), creatine (Cr) and choline (Cho). Participants with WAD completed clinical questionnaires on pain intensity (Visual Analogue Scale), disability (Neck Disability Index) and psychological factors (Pain Catastrophising Scale, Post-traumatic Diagnostic Scale), and underwent cervical range of motion assessment and pain threshold testing to cold and pressure stimuli. Data were analysed using hypothesis testing and Spearman correlations (p < 0.05). Results: There were no differences between the WAD and control groups for NAA/Cr (median [IQR] WAD 1.73 [1.38, 1.97], controls 2.09 [1.28, 2.89], p = 0.37), NAA/Cho (WAD 1.50 [1.18, 2.01], controls 1.57 [1.26, 1.93], p = 0.91) or Cr/Cho (WAD 0.84 [0.64, 1.17], controls 0.76 [0.60, 0.91], p = 0.33). There were no significant correlations between NAA/Cr, NAA/Cho or Cr/Cho and any clinical variable (p ≥ 0.06). Conclusions: Findings are consistent with major metabolic changes not being present in chronic WAD.
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lateral atlantoaxial joint meniscoid volume in individuals with Whiplash Associated Disorder a case control study
Musculoskeletal science and practice, 2018Co-Authors: Michele Sterling, Scott F Farrell, Subaat Khan, Peter G Osmotherly, Jon Cornwall, Darren A RivettAbstract:Abstract Background Lateral atlantoaxial (LAA) joints are established sources of nociceptive input in chronic Whiplash Associated Disorder (WAD). These joints contain intra-articular meniscoids that may be damaged in Whiplash trauma. LAA joint meniscoid morphology has not been investigated comprehensively in a chronic WAD population, and it is unclear whether morphological differences exist compared to a pain-free population. Objectives This study examined LAA joint meniscoid volume in individuals with chronic WAD who report pain in a distribution consistent with LAA joint pain. Design Case-control study. Method Fourteen individuals with chronic WAD with pain in an LAA joint distribution (mean [SD] age 38.1 [10.8] years; six female) and 14 age- and sex-matched pain-free controls (38.0 [10.5] years) underwent cervical spine magnetic resonance imaging. LAA joint images were inspected for meniscoids; meniscoid volume was calculated in mm 3 and as a percentage of articular cavity volume. Symptom duration, location and intensity were recorded. Data were analysed using paired t-tests, Wilcoxon signed-rank testing, Spearman's rank testing, linear and logistic regression (α Results Ventral and dorsal meniscoids (n = 112) were found in each LAA joint. Greater dorsal meniscoid volume as a percentage of articular cavity volume was Associated with higher pain intensity (odds ratio 1.48, p = 0.03; likelihood ratio test chi-square 2 = 6.64, p = 0.04), however no significant differences existed between meniscoid volumes of WAD and control participants. Conclusions Findings indicate a potential link between dorsal LAA joint meniscoid volume and pain, suggesting larger meniscoid size may have pathoanatomical significance in WAD.
Farrell, Scott F. - One of the best experts on this subject based on the ideXlab platform.
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Small fibre pathology in chronic Whiplash-Associated Disorder: a cross-sectional study
'Wiley', 2020Co-Authors: Farrell, Scott F., Sterling Michele, Irving-rodgers Helen, Schmid, Annina B.Abstract:Background: Mechanisms underpinning ongoing symptoms in chronic Whiplash Associated‐Disorder (WAD) are not well understood. People with chronic WAD can exhibit sensory dysfunction consistent with small nerve fibre pathology, including thermal hypoaesthesia and hyperalgesia. This study investigated small fibre structure and function in chronic WAD. Methods: Twenty‐four people with chronic WAD (median [IQR] age 49 [15] years, 16 females) and 24 pain‐free controls (50 [17] years, 16 females) were recruited. Intraepidermal nerve fibre density (IENFD) and dermal innervation were assessed by skin biopsy. This was performed at (a) the lateral index finger on the primary side of pain and (b) superior to the lateral malleolus on the contralateral side. Quantitative sensory testing was performed over the hand. Results: The WAD group exhibited lower IENFD at the finger (WAD: median [IQR] 4.5 [4.9] fibres/mm; control 7.3 [3.9]; p = .010), but not the ankle (WAD: mean [SD] 7.3 [3.7] fibres/mm; control 9.3 [3.8]; p = .09). Dermal innervation was lower in the WAD group at the finger (WAD: median [IQR] 3.7 [2.8] nerve bundles/mm2; controls: 4.9 [2.1]; p = .017) but not the ankle (WAD: median [IQR] 2.1 [1.9] nerve bundles/mm2; controls: 1.8 [1.8]; p = .70). In the WAD group, hand thermal and light touch detection were impaired, and heat pain thresholds were lowered (p ≤ .037). Conclusions: Findings suggest small fibre structural and functional deficits in chronic WAD, implicating potential involvement of small fibre pathology. Significance: Our study found decreased intraepidermal nerve fibre density, reduced dermal innervation, thermal hypoaesthesia and hypersensitivity in people with chronic WAD, suggestive of small fibre pathology. This observation of peripheral nervous system pathology in chronic Whiplash provides novel insights on mechanisms underpinning symptoms and challenges commonly held beliefs regarding this condition
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Magnetic resonance spectroscopy assessment of brain metabolite concentrations in individuals with chronic Whiplash Associated Disorder: a cross-sectional study
'Ovid Technologies (Wolters Kluwer Health)', 2020Co-Authors: Farrell, Scott F., Cowin, Gary J., Pedler Ashley, Durbridge Gail, De Zoete, Rutger M. J., Sterling MicheleAbstract:Pathophysiologic mechanisms underpinning ongoing pain in Whiplash Associated Disorder (WAD) are not well understood, however alterations in brain morphology and function have been observed in this population, as well as in other chronic pain conditions. This study investigated metabolite profiles of brain regions in people with chronic WAD compared with controls.Thirty-eight patients with chronic WAD (mean [SD] age 39.5 [11.3] years, 23 female) and 16 pain-free controls (38.9 [12.7] years, 11 female) underwent multi-voxel brain magnetic resonance spectroscopy. At the anterior cingulate cortex (ACC), primary motor cortex (1MC) and somatosensory cortex (SSC), ratios of metabolite concentrations were calculated for N-acetylaspartate (NAA), creatine (Cr), choline (Cho), myo-inositol (Ins) and glutamate/glutamine (Glx). Chronic WAD group participants completed clinical questionnaires as well as cold and pressure pain threshold assessment. Data were analysed with hypothesis testing and Spearman correlations (P≥0.05), with Benjamini-Hochberg corrections (5% false discovery rate).No group differences were observed for NAA:Cr, NAA:Cho, Cr:Cho, Glx:NAA, Glx:Cr, Glx:Cho, Ins:NAA, Ins:Cr, Ins:Cho or Ins:Glx for left or right ACC, 1MC or SSC following correction for multiple comparisons. No significant correlations were observed between metabolite ratios and any clinical variable.These results suggest that ongoing pain and disability in this population may not be underpinned by metabolite aberrations in the brain regions examined. Further research is required to progress our understanding of cortical contributions to neurophysiologic mechanisms in chronic WAD
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Lateral atlantoaxial joint meniscoid volume in individuals with Whiplash Associated Disorder: A case-control study
'Elsevier BV', 2017Co-Authors: Farrell, Scott F., Sterling Michele, Osmotherly, Peter G., Cornwall Jon, Khan Subaat, Rivett, Darren A.Abstract:Lateral atlantoaxial (LAA) joints are established sources of nociceptive input in chronic Whiplash Associated Disorder (WAD). These joints contain intra-articular meniscoids that may be damaged in Whiplash trauma. LAA joint meniscoid morphology has not been investigated comprehensively in a chronic WAD population, and it is unclear whether morphological differences exist compared to a pain-free population.This study examined LAA joint meniscoid volume in individuals with chronic WAD who report pain in a distribution consistent with LAA joint pain.Case-control study.Fourteen individuals with chronic WAD with pain in an LAA joint distribution (mean [SD] age 38.1 [10.8] years; six female) and 14 age- and sex-matched pain-free controls (38.0 [10.5] years) underwent cervical spine magnetic resonance imaging. LAA joint images were inspected for meniscoids; meniscoid volume was calculated in mm3 and as a percentage of articular cavity volume. Symptom duration, location and intensity were recorded. Data were analysed using paired t-tests, Wilcoxon signed-rank testing, Spearman's rank testing, linear and logistic regression (α\ua
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Morphology of cervical spine meniscoids in individuals with chronic Whiplash-Associated Disorder: a case-control study
'Journal of Orthopaedic & Sports Physical Therapy (JOSPT)', 2016Co-Authors: Farrell, Scott F., Osmotherly, Peter G., Cornwall Jon, Lau Peter, Rivett, Darren A.Abstract:FisheyeSTUDY DESIGN: Case-control study. FisheyeBACKGROUND: Cervical spine meniscoids are thought to contribute to neck pain and hypomobility in individuals with chronic Whiplash-Associated Disorder (WAD); however, their morphology has not been studied in a clinical population. FisheyeOBJECTIVES: To investigate cervical spine meniscoid morphology in individuals with chronic WAD. FisheyeMETHODS: Twenty volunteers with chronic WAD (mean ± SD age, 39.3 ± 11.0 years; 10 female) and 20 age- and sex-matched controls (age, 39.1 ± 10.6 years) underwent cervical spine magnetic resonance imaging. Lateral atlantoaxial and zygapophyseal joints (C2-3 to C6-7) were inspected for meniscoids. Length of meniscoid protrusion was measured and composition (adipose/fibrous/fibroadipose) assessed. Data were analyzed using Wilcoxon signed-rank tests and linear and logistic regression (
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Morphology of cervical spine meniscoids in individuals with chronic Whiplash-Associated Disorder: a case-control study
American Physical Therapy Association Orthopedic Section, 2016Co-Authors: Farrell, Scott F., Osmotherly, Peter G., Cornwall Jon, Lau Peter, Rivett, Darren A.Abstract:Study Design: Case-control study. Background: Cervical spine meniscoids are thought to contribute to neck pain and hypomobility in individuals with chronic Whiplash-Associated Disorder (WAD); however, their morphology has not been studied in a clinical population. Objectives: To investigate cervical spine meniscoid morphology in individuals with chronic WAD. Methods: Twenty volunteers with chronic WAD (mean ± SD age, 39.3 ± 11.0 years; 10 female) and 20 age- and sex-matched controls (age, 39.1 ± 10.6 years) underwent cervical spine magnetic resonance imaging. Lateral atlantoaxial and zygapophyseal joints (C2-3 to C6-7) were inspected for meniscoids. Length of meniscoid protrusion was measured and composition (adipose/fibrous/fibroadipose) assessed. Data were analyzed using Wilcoxon signed-rank tests and linear and logistic regression (P
