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Michele Sterling - One of the best experts on this subject based on the ideXlab platform.
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a randomised controlled trial of implementation of a guideline based clinical pathway of care to improve health outcomes following Whiplash Injury Whiplash impact statistical analysis plan
Revista Brasileira De Fisioterapia, 2021Co-Authors: Michele Sterling, Carrie Ritchie, Luke B Connelly, Trudy Rebbeck, Andrew Leaver, Aila Nica Bandong, Martin Mackey, Ian D CameronAbstract:Background: Statistical analysis plans describe the processes of data handling and analysis in clinical trials; by doing so they increase the transparency of the analysis and reporting of studies. This paper reports the planned statistical analysis plan for the Whiplash ImPaCT study. For individuals with Whiplash Injury, Whiplash ImPaCT aims to assess the effectiveness of a guidelines-based clinical pathway of care compared with usual care. Methods: We report the planned procedures, methods, and reporting for the primary and secondary analyses of the Whiplash ImPaCT study. The primary outcomes are Global Recovery and Neck Disability Index at 3 months post-randomisation. Outcomes will be analysed according to the intention to treat principle using linear mixed models. A cost-utility analysis will be conducted to compute the incremental cost-effectiveness of the intervention to usual care. We describe data handling, our analytical approach, assumptions about missing data, and our planned methods of reporting. Discussion: This paper will provide a detailed description of the planned analyses for the Whiplash ImPaCT trial.
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Recovery Pathways and Prognosis After Whiplash Injury
Journal of Orthopaedic & Sports Physical Therapy, 2016Co-Authors: Carrie Ritchie, Michele SterlingAbstract:Synopsis Recovery from a Whiplash Injury is varied and complex. Some individuals recover quickly and fully, while others experience ongoing pain and disability. Three distinct patterns of predicted recovery (trajectories) have been identified using disability and psychological outcome measures. These trajectories are not linear, and show that recovery, if it is going to occur, tends to happen within the first 3 months of the Injury, with little improvement after this period. Identification of factors associated with poor recovery is accumulating, and since 2000 there have been at least 10 published systematic reviews on prognostic factors for Whiplash-associated disorder. Poor recovery has been consistently reported to be associated with high initial neck pain intensity and neck-related disability, posttraumatic stress symptoms, pain catastrophizing, and, to a lesser extent, low self-efficacy and cold hyperalgesia. Evidence regarding factors, including compensation status, psychological factors, structura...
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addition of posttraumatic stress and sensory hypersensitivity more accurately estimates disability and pain than fear avoidance measures alone after Whiplash Injury
Pain, 2016Co-Authors: Ashley Pedler, Steven J Kamper, Michele SterlingAbstract:The fear avoidance model (FAM) has been proposed to explain the development of chronic disability in a variety of conditions including Whiplash-associated disorders (WADs). The FAM does not account for symptoms of posttraumatic stress and sensory hypersensitivity, which are associated with poor recovery from Whiplash Injury. The aim of this study was to explore a model for the maintenance of pain and related disability in people with WAD including symptoms of PTSD, sensory hypersensitivity, and FAM components. The relationship between individual components in the model and disability and how these relationships changed over the first 12 weeks after Injury were investigated. We performed a longitudinal study of 103 (74 female) patients with WAD. Measures of pain intensity, cold and mechanical pain thresholds, symptoms of posttraumatic stress, pain catastrophising, kinesiophobia, and fear of cervical spine movement were collected within 6 weeks of Injury and at 12 weeks after Injury. Mixed-model analysis using Neck Disability Index (NDI) scores and average 24-hour pain intensity as the dependent variables revealed that overall model fit was greatest when measures of fear of movement, posttraumatic stress, and sensory hypersensitivity were included. The interactive effects of time with catastrophising and time with fear of activity of the cervical spine were also included in the best model for disability. These results provide preliminary support for the addition of neurobiological and stress system components to the FAM to explain poor outcome in patients with WAD.
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external validation of a clinical prediction rule to predict full recovery and ongoing moderate severe disability following acute Whiplash Injury
Journal of Orthopaedic & Sports Physical Therapy, 2015Co-Authors: Carrie Ritchie, Gwendolen Jull, Joan Hendrikz, James M Elliott, Michele SterlingAbstract:Study Design Retrospective secondary analysis of data. Objectives To investigate the external validity of the Whiplash clinical prediction rule (CPR). Background We recently derived a Whiplash CPR to consolidate previously established prognostic factors for poor recovery from a Whiplash Injury and predicted 2 recovery pathways. Prognostic factors for full recovery were being less than 35 years of age and having an initial Neck Disability Index (NDI) score of 32% or less. Prognostic factors for ongoing moderate/severe pain and disability were being 35 years of age or older, having an initial NDI score of 40% or more, and the presence of hyperarousal symptoms. Validation is required to confirm the reproducibility and accuracy of this CPR. Clinician feedback on the usefulness of the CPR is also important to gauge acceptability. Methods A secondary analysis of data from 101 individuals with acute Whiplash-associated disorder who had previously participated in either a randomized controlled clinical trial or p...
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the course of serum inflammatory biomarkers following Whiplash Injury and their relationship to sensory and muscle measures a longitudinal cohort study
PLOS ONE, 2013Co-Authors: Michele Sterling, James M Elliott, Peter J CabotAbstract:Tissue damage or pathological alterations are not detectable in the majority of people with Whiplash associated disorders (WAD). Widespread hyperalgisa, morphological muscle changes and psychological distress are common features of WAD. However little is known about the presence of inflammation and its association with symptom persistence or the clinical presentation of WAD. This study aimed to prospectively investigate changes in serum inflammatory biomarker levels from the acute ( 3 months) stages of Whiplash Injury. It also aimed to determine relationships between biomarker levels and hyperalgesia, fatty muscle infiltrates of the cervical extensors identified on MRI and psychological factors. 40 volunteers with acute WAD and 18 healthy controls participated. Participants with WAD were classified at 3 months as recovered/mild disability or having moderate/severe disability using the Neck Disability Index. At baseline both WAD groups showed elevated serum levels of CRP but by 3 months levels remained elevated only in the moderate/severe group. The recovered/mild disability WAD group had higher levels of TNF-α at both time points than both the moderate/severe WAD group and healthy controls. There were no differences found in serum IL-1β. Moderate relationships were found between hyperalgesia and CRP at both time points and between hyperalgesia and IL-1β 3 months post Injury. There was a moderate negative correlation between TNF-α and amount of fatty muscle infiltrate and pain intensity at 3 months. Only a weak relationship was found between CRP and pain catastrophising and no relationship between biomarker levels and posttraumatic stress symptoms. The results of the study indicate that inflammatory biomarkers may play a role in outcomes following Whiplash Injury as well as being associated with hyperalgesia and fatty muscle infiltrate in the cervical extensors.
Justin Kenardy - One of the best experts on this subject based on the ideXlab platform.
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derivation of a clinical prediction rule to identify both chronic moderate severe disability and full recovery following Whiplash Injury
Pain, 2013Co-Authors: Carrie Ritchie, Joan Hendrikz, Justin Kenardy, Michele SterlingAbstract:Abstract Recovery following a Whiplash Injury is varied: approximately 50% of individuals fully recover, 25% develop persistent moderate/severe pain and disability, and 25% experience milder levels of disability. Identification of individuals likely to develop moderate/severe disability or to fully recover may help direct therapeutic resources and optimise treatment. A clinical prediction rule (CPR) is a research-generated tool used to predict outcomes such as likelihood of developing moderate/severe disability or experiencing full recovery from Whiplash Injury. The purpose of this study was to assess the plausibility of developing a CPR. Participants from 2 prospective, longitudinal studies that examined prognostic factors for poor functional recovery following Whiplash Injury were used to derive this tool. Eight factors, previously identified as predictor variables of poor recovery, were included in the analyses: initial neck disability index (NDI), initial neck pain (visual analogue scale), cold pain threshold, range of neck movement, age, gender, presence of headache, and posttraumatic stress symptoms (Posttraumatic Diagnostic Scale [PDS]). An increased probability of developing chronic moderate/severe disability was predicted in the presence of older age and initially higher levels of NDI and hyperarousal symptoms (PDS) (positive predictive value [PPV] = 71%). The probability of full recovery was increased in younger individuals with initially lower levels of neck disability (PPV = 71%). This study provides initial evidence for a CPR to predict both chronic moderate/severe disability and full recovery following a Whiplash Injury. Further research is needed to validate the tool, determine the acceptability of the proposed CPR by practitioners, and assess the impact of inclusion in practice.
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the temporal development of fatty infiltrates in the neck muscles following Whiplash Injury an association with pain and posttraumatic stress
PLOS ONE, 2011Co-Authors: James M Elliott, Gwendolen Jull, Justin Kenardy, Ashley Pedler, Graham J Galloway, Michele SterlingAbstract:Background: Radiological findings associated with poor recovery following Whiplash Injury remain elusive. Muscle fatty infiltrates (MFI) in the cervical extensors on magnetic resonance imaging (MRI) in patients with chronic pain have been observed. Their association with specific aspects of pain and psychological factors have yet to be explored longitudinally. Materials and Findings: 44 subjects with Whiplash Injury were enrolled at 4 weeks post-Injury and classified at 6 months using scores on the Neck Disability Index as recovered, mild and moderate/severe. A measure for MFI and patient self-report of pain, loss of cervical range of movement and posttraumatic stress disorder (PTSD) were collected at 4 weeks, 3 months and 6 months post-Injury. The effects of time and group and the interaction of time by group on MFI were determined. We assessed the mediating effect of posttraumatic stress and cervical range of movement on the longitudinal relationship between initial pain intensity and MFI. There was no difference in MFI across all groups at enrollment. MFI values increased in the moderate/severe group and were significantly higher in comparison to the recovered and mild groups at 3 and 6 months. No differences in MFI values were found between the mild and recovered groups. Initial severity of PTSD symptoms mediated the relationship between pain intensity and MFI at 6 months. Initial ROM loss did not. Conclusions: MFI in the cervical extensors occur soon following Whiplash Injury and suggest the possibility for the occurrence of a more severe Injury with subsequent PTSD in patients with persistent symptoms.
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similar factors predict disability and posttraumatic stress disorder trajectories after Whiplash Injury
Pain, 2011Co-Authors: Michele Sterling, Joan Hendrikz, Justin KenardyAbstract:Distinct developmental trajectories for neck disability and posttraumatic stress disorder (PTSD) symptoms after Whiplash Injury have recently been identified. This study aimed to identify baseline predictors of membership to these trajectories and to explore their dual development. In a prospective study, 155 individuals with Whiplash were assessed at or = 13° C (OR = 26.320, 95% CI = 4.981-139.09), initial pain level (VAS) (OR = 4.3, 95% CI = 4.98-139.1), and age (OR = 1.109, 95% CI = 1.043-1.180) predicted a chronic/severe disability trajectory. The same baseline factors also predicted chronic moderate/severe PTSD (CPT > or = 13° C, OR = 9.7, 95% CI = 2.22-42.44; initial pain level [VAS]: OR = 2.13, 95% CI = 1.43-3.17; age: OR = 1.07, 95% CI = 1.01-1.14). There was good correspondence of trajectory group for both disability and PTSD. These findings support the proposal of links between the development of chronic neck related disability and PTSD after Whiplash Injury. Developmental trajectories of disability and posttraumatic stress disorder (PTSD) after Whiplash Injury are mostly in synchrony, and similar factors predict their membership. This suggests links between the development of chronic neck pain-related disability and PTSD.
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compensation claim lodgement and health outcome developmental trajectories following Whiplash Injury a prospective study
Pain, 2010Co-Authors: Michele Sterling, Joan Hendrikz, Justin KenardyAbstract:This study aimed to identify distinctive trajectories for pain/disability and posttraumatic stress disorder (PTSD) symptoms following Whiplash Injury and to examine the effect of Injury compensation claim lodgement on the trajectories. In a prospective study, 155 individuals with Whiplash were assessed at <1month, 3, 6 and 12months post Injury. Outcomes at each time point were Neck Disability Index (NDI) and the Posttraumatic Stress Diagnostic Scale (PDS). Group-based trajectory analytical techniques were used to identify outcome profiles. The analyses were then repeated after including third party compensation claim lodgment as a binary time-changing covariate. Three distinct NDI trajectories were determined: (1) Mild: mild or negligible pain/disability for the entire 12 months (45%), (2) Moderate: initial moderate pain/disability that decreased to mild levels by 3 months (39%) and (3) Chronic-severe: severe pain/disability persisting at moderate/severe levels for 12 months (16%). Three distinct PTSD trajectories were also identified: (1) Resilient: mild symptoms throughout (40%), (2) Recovering: initial moderate symptoms declining to mild levels by 3months (43%) and (3) Chronic moderate-severe: persistent moderate/severe symptoms throughout 12 months (17%). Claim submission had a detrimental effect on all trajectories (p<0.001) except for the Chronic-severe NDI trajectory (p=0.098). Following Whiplash Injury, there are distinct pathways of recovery for pain/ disability and PTSD symptoms. Management of Whiplash should consider the detrimental association of compensation claim with psychological recovery and recovery of those with mild to moderate pain/disability levels. However, claim lodgement has no significant association with a more severe pain and disability trajectory.
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the relationship between sensory and sympathetic nervous system changes and posttraumatic stress reaction following Whiplash Injury a prospective study
Journal of Psychosomatic Research, 2006Co-Authors: Michele Sterling, Justin KenardyAbstract:Objective: To investigate differences in sensory and sympathetic nervous system (SNS) function between Whiplash-injured persons with and without a posttraumatic stress reaction (PTSR). To explore associations between sensory, SNS function, and persistent PTSR at 6 months postInjury. Methods: Seventy-six acutely (<1 month) Whiplash-injured persons (10 with PTSR persisting to 6 months postInjury, 14 with early PTSR that resolved, and 52 with no PTSR) were prospectively investigated. Results: Those with persistent PTSR showed sensory hypersensitivity and impaired peripheral vasoconstriction compared to those whose PTSR resolved and those without PTSR (P<.05). The early presence of sensory hypersensitivity was associated with PTSR at 6 months, but this relationship was mediated by pain and disability levels. Impaired vasoconstriction and higher pain and disability levels were associated with PTSR at 6 months. Conclusion: Sensory disturbances following Whiplash Injury are associated with persistent PTSR but may be mediated by levels of pain and disability.
Michele Curatolo - One of the best experts on this subject based on the ideXlab platform.
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modulation of central hypersensitivity by nociceptive input in chronic pain after Whiplash Injury
Pain Medicine, 2004Co-Authors: Renate Herrengerber, Lars Arendtnielsen, Steen Petersenfelix, Bogdan P Radanov, Susanne Weiss, Giuseppe Di Stefano, Michele CuratoloAbstract:Objective. Chronic pain after Whiplash Injury is associated with hypersensitivity of the central nervous system to peripheral stimulation. It is unclear whether central hypersensitivity is modulated by peripheral nociceptive input. We hypothesized that changes in nociceptive input would correlate with changes in magnitude of central hypersensitivity. Design. Fifteen patients with chronic pain after Whiplash Injury were investigated. Changes in nociceptive input were induced by infiltration of painful and tender muscles with bupivacaine (0.25%). Such infiltrations produce either pain reduction or pain enhancement, the latter effect probably resulting from transient injection-induced trauma. We used this individual variability in correlation analyses. Changes in intensity of neck pain, as assessed by a visual analog scale (VAS), after infiltration were assumed to reflect changes in nociceptive input. Changes in pressure pain thresholds recorded at healthy tissues (nonpainful point of the neck and the second toe) were used to measure changes in central hypersensitivity. The correlations between the change in VAS score and changes in pressure pain thresholds 15 minutes after infiltration were analyzed. Results. Statistically significant negative correlations were found between change in VAS score and changes in threshold measurements performed at the neck, but not at the toe. Conclusions. Different mechanisms underlie hyperalgesia localized at areas surrounding the site of pain and hyperalgesia generalized to distant body areas. Central hypersensitivity as a determinant of neck pain is probably a dynamic condition that is influenced by the presence and activity of a nociceptive focus.
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evidence mechanisms and clinical implications of central hypersensitivity in chronic pain after Whiplash Injury
The Clinical Journal of Pain, 2004Co-Authors: Michele Curatolo, Lars Arendtnielsen, Steen PetersenfelixAbstract:Objectives To provide insights into the mechanisms underlying central hypersensitivity, review the evidence on central hypersensitivity in chronic pain after Whiplash Injury, highlight reflections on the clinical relevance of central hypersensitivity, and offer a perspective of treatment of central hypersensitivity. Methods A review of animal and human studies focusing on the mechanisms of postInjury central sensitization, an analysis of psychophysical investigations on central hypersensitivity in patients with chronic pain after Whiplash Injury, and a review of possible treatment modalities. Results Animal data show that tissue damage produces plasticity changes at different neuronal structures that are responsible for amplification of nociception and exaggerated pain responses. Some of these changes are potentially irreversible. There is consistent psychophysical evidence for hypersensitivity of the central nervous system to sensory stimulation in chronic pain after Whiplash Injury. Tissue damage, detected or not by the available diagnostic methods, is probably the main determinant of central hypersensitivity. Psychologic distress could contribute to central hypersensitivity via imbalance of supraspinal and descending modulatory mechanisms. Although specific treatment strategies are limited, they are largely unexplored. Implications Central hypersensitivity may explain exaggerated pain in the presence of minimal nociceptive input arising from minimally damaged tissues. This could account for pain and disability in the absence of objective signs of tissue damage in patients with Whiplash. Central hypersensitivity may provide a common neurobiological framework for the integration of peripheral and supraspinal mechanisms in the pathophysiology of chronic pain after Whiplash. Therapy studies are needed.
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evidence for spinal cord hypersensitivity in chronic pain after Whiplash Injury and in fibromyalgia
Pain, 2004Co-Authors: Borut Banic, Lars Arendtnielsen, Steen Petersenfelix, Bogdan P Radanov, Ole Kaeseler Andersen, Peter M Villiger, Michele CuratoloAbstract:Patients with chronic pain after Whiplash Injury and fibromyalgia patients display exaggerated pain after sensory stimulation. Because evident tissue damage is usually lacking, this exaggerated pain perception could be explained by hyperexcitability of the central nervous system. The nociceptive withdrawal reflex (a spinal reflex) may be used to study the excitability state of spinal cord neurons. We tested the hypothesis that patients with chronic Whiplash pain and fibromyalgia display facilitated withdrawal reflex and therefore spinal cord hypersensitivity. Three groups were studied: Whiplash (n=27), fibromyalgia (n=22) and healthy controls (n=29). Two types of transcutaneous electrical stimulation of the sural nerve were applied: single stimulus and five repeated stimuli at 2 Hz. Electromyography was recorded from the biceps femoris muscle. The main outcome measurement was the minimum current intensity eliciting a spinal reflex (reflex threshold). Reflex thresholds were significantly lower in the Whiplash compared with the control group, after both single (P=0.024) and repeated (P=0.035) stimulation. The same was observed for the fibromyalgia group, after both stimulation modalities (P=0.001 and 0.046, respectively). We provide evidence for spinal cord hyperexcitability in patients with chronic pain after Whiplash Injury and in fibromyalgia patients. This can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain, at least in part, pain in the absence of detectable tissue damage.
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central hypersensitivity in chronic pain after Whiplash Injury
The Clinical Journal of Pain, 2001Co-Authors: Michele Curatolo, Lars Arendtnielsen, Steen Petersenfelix, Carmela Giani, A M Zbinden, Bogdan P RadanovAbstract:Objective: The mechanisms underlying chronic pain after Whiplash Injury are usually unclear. Injuries may cause sensitization of spinal cord neurons in animals (central hypersensitivity), which results in increased responsiveness to peripheral stimuli. In humans, the responsiveness of the central nervous system to peripheral stimulation may be explored by applying sensory tests to healthy tissues. The hypotheses of this study were: (1) chronic Whiplash pain is associated with central hypersensitivity; (2) central hypersensitivity is maintained by nociception arising from the painful or tender muscles in the neck. Design: Comparison of patients with healthy controls. Setting: Pain clinic and laboratory for pain research, university hospital. Patients: Fourteen patients with chronic neck pain after Whiplash Injury (car accident) and 14 healthy volunteers. Outcome Measures: Pain thresholds to: single electrical stimulus (intramuscular), repeated electrical stimulation (intramuscular and transcutaneous), and heat (transcutaneous). Each threshold was measured at neck and lower limb, before and after local anesthesia of the painful and tender muscles of the neck. Results: The Whiplash group had significantly lower pain thresholds for all tests, except heat, at both neck and lower limb. Local anesthesia of the painful and tender points affected neither intensity of neck pain nor pain thresholds. Conclusions: The authors found a hypersensitivity to peripheral stimulation in Whiplash patients. Hypersensitivity was observed after cutaneous and muscular stimulation, at both neck and lower limb. Because hypersensitivity was observed in healthy tissues, it resulted from alterations in the central processing of sensory stimuli (central hypersensitivity). Central hypersensitivity was not dependent on a nociceptive input arising from the painful and tender muscles.
Michael J L Sullivan - One of the best experts on this subject based on the ideXlab platform.
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Reductions in Perceived Injustice Are Associated with Reductions in Posttraumatic Stress Symptoms Among Individuals Receiving Treatment for Whiplash Injury
Psychological Injury and Law, 2018Co-Authors: Esther Yakobov, Michael J L SullivanAbstract:Research has accumulated to suggest that perceived injustice is a risk factor for poor recovery outcomes in individuals with Whiplash injuries. The present study examined the relative contributions of treatment-related reductions in perceived injustice and pain severity, in the prediction of reductions in posttraumatic stress symptoms in individuals with Whiplash Injury. The study sample consisted of 146 individuals (66 women, 80 men) who sustained Whiplash injuries in motor vehicle collisions and were enrolled in a multidisciplinary rehabilitation program designed to promote functional recovery following Whiplash Injury. Participants completed measures of pain severity, disability, posttraumatic stress symptoms, and perceived injustice prior to treatment and after treatment. Pearson correlations revealed that all study variables were significantly correlated. Regression analyses revealed that, at the time of enrollment in the intervention, perceived injustice accounted for a significant proportion of the variance in posttraumatic stress symptom severity, beyond the variance accounted for by pain severity. Paired sample t -tests revealed significant reductions in perceived injustice, pain severity, and posttraumatic stress symptom severity through the course of treatment. For individuals who scored above clinical threshold on a measure of posttraumatic stress symptoms at the time of enrollment in the intervention ( N = 71), regression analyses revealed that reductions in perceived injustice accounted for a significant proportion of the variance in reduction of posttraumatic stress symptoms, beyond the variance accounted for by reduced pain severity. Clinical and theoretical implications of the present findings are discussed.
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sensitivity to movement evoked pain and multi site pain are associated with work disability following Whiplash Injury a cross sectional study
Journal of Occupational Rehabilitation, 2017Co-Authors: Tsipora Mankovskyarnold, Timothy H Wideman, Pascal Thibault, Christian Lariviere, Pierre Rainville, Michael J L SullivanAbstract:Objectives Previous research has shown that sensitivity to movement-evoked pain is associated with higher scores on self-report measures of disability in individuals who have sustained Whiplash injuries. However, it remains unclear whether sensitivity to movement-evoked pain is associated with work-disability. The aim of the present study was to examine the relation between sensitivity to movement-evoked pain and occupational status in individuals receiving treatment for Whiplash Injury. Methods A sample of 105 individuals with Whiplash injuries participated in a testing session where different measures of pain (i.e. spontaneous pain, multi-site pain, sensitivity to movement-evoked pain) were collected during the performance of a simulated occupational lifting task. Results Hierarchical logistic regression analysis revealed that the measures of multisite pain and sensitivity to movement-evoked pain made significant independent contributions to the prediction of work-disability. Discussion The findings suggest that including measures of multisite pain and sensitivity to movement evoked pain in assessment protocols has the potential to increase the value of pain assessments for the prediction of occupational disability associated with Whiplash Injury. Clinical and theoretical implications of the findings are addressed.
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expectancies mediate the relationship between perceived injustice and return to work following Whiplash Injury a 1 year prospective study
European Journal of Pain, 2017Co-Authors: Junie S Carriere, Heather Adams, Pascal Thibault, Maria Milioto, Blaine Ditto, Michael J L SullivanAbstract:Background Emerging evidence suggests that perceived injustice is a risk factor for work disability in individuals with Whiplash Injury. At present, however, little is known about the processes by which perceived injustice impacts on return to work. The purpose of this study was to examine whether expectancies mediated the relationship between perceived injustice and return to work in patients with Whiplash Injury. Method One hundred and fifty-two individuals (81 men, 71 women) with a primary diagnosis of Whiplash Injury completed self-report measures of pain intensity, perceived injustice and return-to-work expectancies following admission to a rehabilitation programme. Work status was assessed 1 year after discharge. Results Consistent with previous research, high scores on a measure of perceived injustice were associated with prolonged work disability. Results indicated that high perceptions of injustice were associated with low return-to-work expectancies. Causal mediation analyses revealed that expectancies fully mediated the relationship between perceived injustice and return to work. Conclusion The findings suggest that intervention techniques designed to target expectancies could improve return-to-work outcomes in patients with Whiplash Injury. Discussion addresses the processes by which expectancies might impact on return-to-work outcomes and the manner in which negative return-to-work expectancies might be modified through intervention. Significance The study confirms that expectancies are the mechanism through which perceived injustice impacts return to work following Whiplash Injury. The findings suggest that interventions designed to specifically target return-to-work expectancies might improve rehabilitation outcomes in patients with Whiplash Injury.
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expectancies mediate the relations among pain catastrophizing fear of movement and return to work outcomes after Whiplash Injury
The Journal of Pain, 2015Co-Authors: Junie S Carriere, Pascal Thibault, Maria Milioto, Michael J L SullivanAbstract:Abstract Pain catastrophizing and fear of movement have been identified as key predictors of prolonged work disability after Whiplash Injury. However, little is known about the processes by which pain catastrophizing and fear of movement affect return to work. This study investigated the mediating role of expectancies on the relations between pain catastrophizing and return to work, and between fear of movement and return to work after Whiplash Injury. The study sample consisted of 154 individuals with Whiplash Injury who were enrolled in a multidisciplinary pain rehabilitation program. Participants completed measures of pain catastrophizing, fear of movement, and return-to-work expectancies after admission to a rehabilitation program. A follow-up telephone interview was used to assess work status 1 year after discharge. Consistent with previous research, analyses revealed that expectancies, pain catastrophizing, and fear of movement were significant predictors of return to work at 1-year follow-up. Regression analyses (bootstrapping) revealed that expectancies partially mediated the relation between catastrophizing and return to work. Expectancies completely mediated the relation between fear of movement and return to work. The significant predictive and mediating role of expectancies on return to work argues for the inclusion of expectancies as a specific target of intervention for individuals with Whiplash Injury. Perspective The findings suggest that expectancies might be part of the pathways by which pain catastrophizing and fear of movement affect return-to-work outcomes after Whiplash Injury. The findings argue for greater attention to return-to-work expectancies as a risk factor for problematic recovery outcomes as well as a target of intervention.
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catastrophizing and perceived injustice risk factors for the transition to chronicity after Whiplash Injury
Spine, 2011Co-Authors: Michael J L Sullivan, Heather Adams, Marcolivier Martel, Whitney Scott, Timothy H WidemanAbstract:Study design The article will summarize research that has supported the role of pain catastrophizing and perceived injustice as risk factors for problematic recovery after Whiplash Injury. Objective This article focuses on two psychological variables that have been shown to impact on recovery trajectories after Whiplash Injury; namely pain catastrophizing and perceived injustice. Summary of background data Research has shown that psychological variables play a role in determining the trajectory of recovery after Whiplash Injury. Methods This article will focus on two psychological variables that have been shown to impact on recovery trajectories after Whiplash Injury; namely pain catastrophizing and perceived injustice. The article will summarize research that has supported the role of pain catastrophizing and perceived injustice as risk factors for problematic recovery after Whiplash Injury. Results Several investigations have shown that measures of catastrophizing and perceived injustice prospectively predict problematic trajectories of recovery after Whiplash Injury. Basic research points to the potential roles of expectancies, attention, coping and endogenous opioid dysregulation as possible avenues through which catastrophizing might heighten the probability of the persistence of pain after Whiplash Injury. Although research has yet to systematically address the mechanisms by which perceived injustice might contribute to prolonged disability in individuals with Whiplash injuries, there are grounds for suggesting the potential contributions of catastrophizing, pain behavior and anger. Conclusion A challenge for future research will be the development and evaluation of risk factor-targeted interventions aimed at reducing catastrophizing and perceived injustice to improve recovery trajectories after Whiplash Injury.
Lars Arendtnielsen - One of the best experts on this subject based on the ideXlab platform.
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modulation of central hypersensitivity by nociceptive input in chronic pain after Whiplash Injury
Pain Medicine, 2004Co-Authors: Renate Herrengerber, Lars Arendtnielsen, Steen Petersenfelix, Bogdan P Radanov, Susanne Weiss, Giuseppe Di Stefano, Michele CuratoloAbstract:Objective. Chronic pain after Whiplash Injury is associated with hypersensitivity of the central nervous system to peripheral stimulation. It is unclear whether central hypersensitivity is modulated by peripheral nociceptive input. We hypothesized that changes in nociceptive input would correlate with changes in magnitude of central hypersensitivity. Design. Fifteen patients with chronic pain after Whiplash Injury were investigated. Changes in nociceptive input were induced by infiltration of painful and tender muscles with bupivacaine (0.25%). Such infiltrations produce either pain reduction or pain enhancement, the latter effect probably resulting from transient injection-induced trauma. We used this individual variability in correlation analyses. Changes in intensity of neck pain, as assessed by a visual analog scale (VAS), after infiltration were assumed to reflect changes in nociceptive input. Changes in pressure pain thresholds recorded at healthy tissues (nonpainful point of the neck and the second toe) were used to measure changes in central hypersensitivity. The correlations between the change in VAS score and changes in pressure pain thresholds 15 minutes after infiltration were analyzed. Results. Statistically significant negative correlations were found between change in VAS score and changes in threshold measurements performed at the neck, but not at the toe. Conclusions. Different mechanisms underlie hyperalgesia localized at areas surrounding the site of pain and hyperalgesia generalized to distant body areas. Central hypersensitivity as a determinant of neck pain is probably a dynamic condition that is influenced by the presence and activity of a nociceptive focus.
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evidence mechanisms and clinical implications of central hypersensitivity in chronic pain after Whiplash Injury
The Clinical Journal of Pain, 2004Co-Authors: Michele Curatolo, Lars Arendtnielsen, Steen PetersenfelixAbstract:Objectives To provide insights into the mechanisms underlying central hypersensitivity, review the evidence on central hypersensitivity in chronic pain after Whiplash Injury, highlight reflections on the clinical relevance of central hypersensitivity, and offer a perspective of treatment of central hypersensitivity. Methods A review of animal and human studies focusing on the mechanisms of postInjury central sensitization, an analysis of psychophysical investigations on central hypersensitivity in patients with chronic pain after Whiplash Injury, and a review of possible treatment modalities. Results Animal data show that tissue damage produces plasticity changes at different neuronal structures that are responsible for amplification of nociception and exaggerated pain responses. Some of these changes are potentially irreversible. There is consistent psychophysical evidence for hypersensitivity of the central nervous system to sensory stimulation in chronic pain after Whiplash Injury. Tissue damage, detected or not by the available diagnostic methods, is probably the main determinant of central hypersensitivity. Psychologic distress could contribute to central hypersensitivity via imbalance of supraspinal and descending modulatory mechanisms. Although specific treatment strategies are limited, they are largely unexplored. Implications Central hypersensitivity may explain exaggerated pain in the presence of minimal nociceptive input arising from minimally damaged tissues. This could account for pain and disability in the absence of objective signs of tissue damage in patients with Whiplash. Central hypersensitivity may provide a common neurobiological framework for the integration of peripheral and supraspinal mechanisms in the pathophysiology of chronic pain after Whiplash. Therapy studies are needed.
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quantitative posturography in altered sensory conditions a way to assess balance instability in patients with chronic Whiplash Injury
Archives of Physical Medicine and Rehabilitation, 2004Co-Authors: Pascal Madeleine, Hanne Prietzel, Heine Svarrer, Lars ArendtnielsenAbstract:Abstract Madeleine P, Prietzel H, Svarrer H, Arendt-Nielsen L. Quantitative posturography in altered sensory conditions: a way to assess balance instability in patients with chronic Whiplash Injury. Arch Phys Med Rehabil 2004;85: 432–8. Objectives To quantify neck mobility and posture with and without various postural perturbations. Design A multivariable 2-group study with repeated measures and treatments. Setting A human performance laboratory. Participants Eleven patients with chronic Whiplash Injury (mean age, 33.3±6.7y; weight, 73.4±11.4kg; height, 173.3±7.2cm) with a sex- and age-matched control group (mean age, 33.1±6.8y; weight, 68±12.5kg; height, 171.5±6.3cm). Interventions Neck mobility and the effects of postural perturbations affecting the visual, vestibular, cutaneous, proprioceptive, and nociceptive systems were measured. Main outcome measures Active range of motion, neck position sense, and postural activity. Results We found significantly reduced neck mobility and increased postural activity in the patient group compared with the control group. In patients, there was significantly greater postural activity with eyes closed, eyes open and speaking, and eyes closed with Achilles' tendons vibrations compared with eyes open with no vibrations. In the controls, there was no significant effect of experimental muscle pain on postural activity. Conclusions Patients with chronic Whiplash Injury had a protective response to neck movement and different tuning, sequencing, and execution of the postural synergies probably because of excessive reliance on visual input despite a possible deficit and altered vestibular and/or proprioceptive activity. In healthy volunteers, the pain induced by a single bolus injection of hypertonic saline was probably too limited in intensity and spreading to decrease postural stability.
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evidence for spinal cord hypersensitivity in chronic pain after Whiplash Injury and in fibromyalgia
Pain, 2004Co-Authors: Borut Banic, Lars Arendtnielsen, Steen Petersenfelix, Bogdan P Radanov, Ole Kaeseler Andersen, Peter M Villiger, Michele CuratoloAbstract:Patients with chronic pain after Whiplash Injury and fibromyalgia patients display exaggerated pain after sensory stimulation. Because evident tissue damage is usually lacking, this exaggerated pain perception could be explained by hyperexcitability of the central nervous system. The nociceptive withdrawal reflex (a spinal reflex) may be used to study the excitability state of spinal cord neurons. We tested the hypothesis that patients with chronic Whiplash pain and fibromyalgia display facilitated withdrawal reflex and therefore spinal cord hypersensitivity. Three groups were studied: Whiplash (n=27), fibromyalgia (n=22) and healthy controls (n=29). Two types of transcutaneous electrical stimulation of the sural nerve were applied: single stimulus and five repeated stimuli at 2 Hz. Electromyography was recorded from the biceps femoris muscle. The main outcome measurement was the minimum current intensity eliciting a spinal reflex (reflex threshold). Reflex thresholds were significantly lower in the Whiplash compared with the control group, after both single (P=0.024) and repeated (P=0.035) stimulation. The same was observed for the fibromyalgia group, after both stimulation modalities (P=0.001 and 0.046, respectively). We provide evidence for spinal cord hyperexcitability in patients with chronic pain after Whiplash Injury and in fibromyalgia patients. This can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain, at least in part, pain in the absence of detectable tissue damage.
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central hypersensitivity in chronic pain after Whiplash Injury
The Clinical Journal of Pain, 2001Co-Authors: Michele Curatolo, Lars Arendtnielsen, Steen Petersenfelix, Carmela Giani, A M Zbinden, Bogdan P RadanovAbstract:Objective: The mechanisms underlying chronic pain after Whiplash Injury are usually unclear. Injuries may cause sensitization of spinal cord neurons in animals (central hypersensitivity), which results in increased responsiveness to peripheral stimuli. In humans, the responsiveness of the central nervous system to peripheral stimulation may be explored by applying sensory tests to healthy tissues. The hypotheses of this study were: (1) chronic Whiplash pain is associated with central hypersensitivity; (2) central hypersensitivity is maintained by nociception arising from the painful or tender muscles in the neck. Design: Comparison of patients with healthy controls. Setting: Pain clinic and laboratory for pain research, university hospital. Patients: Fourteen patients with chronic neck pain after Whiplash Injury (car accident) and 14 healthy volunteers. Outcome Measures: Pain thresholds to: single electrical stimulus (intramuscular), repeated electrical stimulation (intramuscular and transcutaneous), and heat (transcutaneous). Each threshold was measured at neck and lower limb, before and after local anesthesia of the painful and tender muscles of the neck. Results: The Whiplash group had significantly lower pain thresholds for all tests, except heat, at both neck and lower limb. Local anesthesia of the painful and tender points affected neither intensity of neck pain nor pain thresholds. Conclusions: The authors found a hypersensitivity to peripheral stimulation in Whiplash patients. Hypersensitivity was observed after cutaneous and muscular stimulation, at both neck and lower limb. Because hypersensitivity was observed in healthy tissues, it resulted from alterations in the central processing of sensory stimuli (central hypersensitivity). Central hypersensitivity was not dependent on a nociceptive input arising from the painful and tender muscles.
