Assessing pain perception using the Painmatcher® in patients with whiplash-associated disorders (original) (raw)
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The Clinical Journal of Pain, 2011
Objectives: Increased sensitivity to pressure is commonly associated with painful musculoskeletal conditions, including whiplash-associated disorders (WADs). Pressure pain thresholds (PPTs) close to the site of presumed tissue damage are thought to represent the degree of peripheral nociceptive sensitization. PPTs over healthy tissue, away from the site of injury, are a marker of central nervous system hyperexcitability. There is uncertainty, however, as to what extent does the sensitization of the nociceptive system, whether peripheral or central, contribute to the ongoing, habitual pain experienced by people with WAD.
Pain and pain tolerance in whiplash‐associated disorders: A population‐based study
European Journal of Pain, 2015
Background: Pain is a cardinal symptom in individuals with whiplashassociated disorders (WAD). We aimed to compare pain characteristics between individuals with WAD and individuals reporting chronic pain from other causes, and to determine whether potential differences were accounted for by experimental pain tolerance. Methods: Data from the 6th Tromsø Study (2007-2008, n = 12,981) were analysed. The number of painful locations was compared between individuals with WAD and individuals reporting chronic pain from other causes using negative binomial regression, pain frequency using multinomial logistic regression and pain intensity using multiple linear regression. Differences in experimental pain tolerance (cold pressor test) were tested using Cox regression; one model compared individuals with WAD to those with chronic pain from other causes, one compared the two groups with chronic pain to individuals without chronic pain. Subsequently, regression models investigating clinical pain characteristics were adjusted for pain tolerance. Results: Of individuals with WAD, 96% also reported other causes for pain. Individuals with WAD reported a higher number of painful locations [median (inter-quartile range): 5 (3.5-7) vs. 3 (2-5), p < 0.001] and higher pain intensity (crude mean difference = 0.78, p < 0.001) than individuals with chronic pain from other causes. Pain tolerance did not differ between these two groups. Compared to individuals without chronic pain, individuals with WAD and individuals with chronic pain from other causes had reduced pain tolerance. Conclusions: Individuals with WAD report more additional causes of pain, more painful locations and higher pain intensity than individuals with chronic pain from other causes. The increased pain reporting was not accounted for by pain tolerance.
Spine, 2001
Study Design. A quasi-experimental design was used to compare the Symptom Checklist 90-Revised profiles (SCL-90-R) from a group of patients with whiplash injuries (n ϭ 67) and a group with mixed musculoskeletal pain (n ϭ 91). Objectives. To test the discriminant validity of the characteristic SCL-90-R whiplash profile as proposed by Wallis and Bogduk using a multivariate statistical technique. Summary of Background Data. On the basis of two studies by themselves and their colleagues, Wallis and Bogduk proposed a characteristic SCL-90-R profile evident in samples of patients with whiplash injuries. Their assertion has not been tested empirically in any published studies. Methods. The participants in this study consisted of 158 patients at a rehabilitation hospital who completed the SCL-90-R under standard instructions and subsequently were diagnosed by a team comprising a chiropractor, physical therapist, and physician. The participants were categorized as having whiplash-associated disorders or pain caused by other musculoskeletal injuries. A profile analysis following Hotelling's method was used to determine the comparability of SCL-90-R profiles from the two groups. Results. The profile analysis showed no statistically significant differences between the groups with regard to either the shape or the overall elevation of their psychological profiles. The SCL-90-R profiles from both groups were similar to those reported from other chronic pain syndromes, with elevations on the Somatization, Depression, Obsessive-Compulsive, and Psychoticism scales. Conclusions. The current study failed to support the validity of a distinctive SCL-90-R profile for patients with whiplash injuries. Instead, the results suggest that the psychological consequences of experiencing chronic pain from whiplash-associated disorders are similar to the psychological consequences of chronic pain from other musculoskeletal injuries.
Pain-Related Emotions in Early Stages of Recovery in Whiplash-Associated Disorders
Psychosomatic Medicine, 2011
Objective: Psychological factors such as depression affect recovery after whiplash-associated disorders. This study examined the prevalence of pain-related emotions, such as frustration, anger, and anxiety, and their predictive value for postcrash pain recovery during a 1-year follow-up. Methods: A population-based prospective cohort study design was used. Self-reported pain-related depression, anxiety, fear, anger, and frustration were assessed using 100-mm visual analog scales (VASs) at 6 weeks after crash in 2986 persons with traffic-related whiplash-associated disorder. Multivariable logistic regression was used to assess the relationship between the intensity of these pain-related emotions and pain recovery at 4 and 12 months after crash. Pain was measured at all time points on a 100-mm VAS, and pain recovery was defined as a score of 10 or lower. Results: Pain-related frustration was the most intense, with a mean score of 52. Only 3% of the cohort reported having no pain-related frustration, and 4% reported no pain-related anxiety. Multivariable logistic regression models revealed that each pain-related emotion increased the risk of failing to recover (odds ratios for each point increase on the 100-mm VAS), ranging from 1.011 to 1.015. Specifically, with each 10-point increase in pain-related emotion, the odds of failing to achieve pain recovery at 4 months was increased by 14% ( p G .
PAIN, 2012
The aim of this study was to test the capacity of the Fear Avoidance Model to explain the relationship between pain and disability in patients with whiplash-associated disorders. Using the method of Baron and Kenny [1], we assessed the mediating effect of fear of movement on the cross-sectional and longitudinal relationships between pain and disability. Two hundred and five subjects with neck pain due to a motor vehicle accident provided pain intensity (0 to 10 numerical rating scale), fear of movement (Tampa Scale of Kinesiophobia and Pictorial Fear of Activity Scale) and disability (Neck Disability Index) scores within 4 weeks of their accident, after 3 months, and after 6 months. The analyses were consistent with the Fear Avoidance Model mediating approximately 20% to 40% of the relationship between pain and disability. Contrary to our initial hypothesis, the proportion of the total effect of pain on disability that was mediated by fear of movement did not substantially change as increasing time elapsed after the accident. The proportion mediated was slightly higher when fear of movement was measured by Tampa Scale of Kinesiophobia as compared with Pictorial Fear of Activity Scale. The findings of this study suggest that the Fear Avoidance Model plays a role in explaining a moderate proportion of the relationship between pain and disability after whiplash injury.
The late whiplash syndrome: a psychophysical study
European Journal of Pain, 2002
Some patients who have sustained whiplash injuries present with chronic widespread pain and mechanical allodynia. This single-blind, case control matched study of 43 chronic whiplash patients sought to examine psychophysical responses to non-noxious stimuli and their relationship to psychological profiles. Symptom Check List 90-R (SCL-90-R), Neck Disability Index and Shortform McGill Questionnaire were completed prior to testing. Qualitative stimuli comprised light touch, punctate pressure, moderate heat and cold. Additionally, sustained vibration was administered using a vibrameter which allowed ramping of either frequency or amplitude. Twenty-eight patients reported vibration-induced pain. No control subject experienced pain in response to vibration. No significant differences in perception threshold to vibration were noted between patients and control group. Twenty-three patients and ten control subjects reported painful responses to cold. Eleven patients and nine control subjects experienced pain in response to moderate heat. Four patients rated punctate pressure and one patient rated light touch as painful. SCL-90-R profiles revealed an overall elevated level of distress in the whiplash group. No significant difference was found between patients with and without vibration-induced pain for any dimension of the SCL-90-R. Pain in response to non-noxious stimulation over presumably healthy tissues suggests that central mechanisms are responsible for ongoing pain in at least some whiplash patients. The additional findings of pain on punctate pressure and hyperalgesic responses to heat and cold stimuli are consistent with enhanced central responsiveness to nociceptor input. These results have important therapeutic and prognostic implications. #
Journal of Rehabilitation Medicine, 2007
The main aims of this study were: (i) to determine, for chronic whiplash-associated disorders, whether widespread pain has more severe consequences for other symptoms and different aspects of perceived health than does local/regional pain; (ii) to investigate whether pain, depression, and symptoms not directly related to pain are intercorrelated and to what extent these symptoms correlate with catastrophizing according to the Coping Strategy Questionnaire. Design: Descriptive cross-sectional study. Patients: A total of 275 consecutive chronic pain patients with whiplash-associated disorders who were referred to a university hospital. Methods: Background history, Beck Depression Inventory, Coping Strategy Questionnaire, Life Satisfaction Checklist, the SF-36 Health Survey and EuroQol were used to collect data. Results: Spreading of pain was associated with negative consequences with respect to pain intensity and prevalence of other symptoms, life satisfaction/quality and general health. The subjects differ with respect to the presence of symptoms not directly related to pain. A minor part of the variation in Back Depression Inventory was explained by direct aspects of pain, indicating that, to some extent, generalization of pain is related to catastrophizing thoughts. Conclusion: Widespread pain was associated with negative consequences with respect to pain intensity, prevalence of other symptoms including depressive symptoms, some aspects of coping, life satisfaction and general health.
Self-report Measures for Symptom Validity Assessment in Whiplash-associated Disorders
The European Journal of Psychology Applied to Legal Context
Background/Objective: Whiplash-Associated Disorders (WAD) are one of the most complex conditions to evaluate because several of its symptoms are not observable with current diagnostic methods and cannot be quantified or evaluated correctly. No method is currently available to assess the risk of malingering in the aforementioned condition efficiently. Our aim is to study the capacity of several biopsychosocial psychometric self-report instruments, such as the Brief Pain Inventory (BPI), the Cervical Disability Index (NDI), the SF-36 Health Questionnaire, the Beck Anxiety and Depression Inventories (BDI-II and BAI), or the Brief Illness Perception Questionnaire (BIPQ), to discriminate between patients diagnosed with WAD following a vehicle accident and non-clinical participants with malingering instructions. Method: A simulation design was used with 630 participants: 200 non-clinical controls with honest responding condition, 201 instructed malingerers, and 229 WAD clinical outpatients. Results: Our results showed an AUC range of .60 to .90, with the highest value being that of the BPI (.90), followed by the NDI (.88), and the lowest value that of the BIPQ (.60), followed by the BAI (.71). Conclusions: Overall, the BPI, the NDI, and SF-36 can correctly discriminate between groups with a good specificity (> 90%), while the BAI, BDI, and BIPQ showed a lower capacity, with a high rate of false positives in the case of the BDI and of false negatives in the other two. Practical and research implications are discussed. Medidas de autoinforme para la evaluación de la validez de los síntomas del síndrome del latigazo cervical R E S U M E N Antecedentes/Objetivo: El Síndrome del Latigazo Cervical (WAD) es una de las condiciones más complejas de evaluar debido a que varios de los síntomas que presenta no son objetivables con los métodos diagnósticos actuales y no puede cuantificarse ni evaluarse correctamente. En la actualidad no se dispone de ningún método eficiente para valorar el riesgo de simulación en la citada condición. Nuestro objetivo es estudiar la capacidad de varios instrumentos psicométricos biopsicosociales de autoinforme, como el Inventario Breve de Dolor (BPI), el Índice de Discapacidad Cervical (NDI), el Cuestionario de Salud SF-36, los Inventarios de Ansiedad y Depresión de Beck (BDI-II y BAI) o el Cuestionario Breve de Percepción de la Enfermedad (BIPQ) para discriminar entre pacientes diagnosticados con WAD tras un accidente de circulación y participantes no-clínicos con instrucciones de simulación. Método: Se utilizó un diseño de simulación con 630 participantes: 200 controles no clínicos con condición de respuesta honesta, 201 simuladores instruidos y 229 pacientes clínicos con WAD. Resultados: Nuestros resultados mostraron un rango de AUC de .60 a .90, siendo el valor más alto el del BPI (.90), seguido del NDI (.88), y el valor más bajo el del BIPQ (.60), seguido del BAI (.71). Conclusiones: En general, el BPI, el NDI y el SF-36 pueden discriminar correctamente entre grupos con una buena especificidad (> 90%), mientras que el BAI, el BDI y el BIPQ mostraron una menor capacidad, con una alta tasa de falsos positivos en el caso del BDI y falsos negativos en los otros dos. Se discuten además las implicaciones prácticas y de investigación.