Premium
Reduced cold pressor pain tolerance in non‐recovered whiplash patients: a 1‐year prospective study
Author(s) -
Kasch Helge,
Qerama Erisela,
Bach Flemming Winther,
Jensen Troels Staehelin
Publication year - 2005
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1016/j.ejpain.2004.11.011
Subject(s) - cold pressor test , whiplash , medicine , prospective cohort study , anesthesia , emergency medicine , blood pressure , poison control , heart rate
Whiplash injury and chronic whiplash syndrome represent major health problems in certain western communities, pain being the main symptom. Sensitization of the nociceptive system may play a role for non‐recovery after whiplash injury. Aims: This study examined if tolerance to endure pain stimuli may predict outcome in whiplash injury. In a prospective fashion, 141 acute whiplash patients exposed to rear‐end car collision (WAD grade 1–3) and 40 ankle‐injured controls were followed and exposed to a cold pressor test, respectively, 1 week, 1, 3, 6 and 12 months after the injury. VAS score of pain and discomfort was obtained before, during and after immersion of the dominant hand into cold water for 2 min. The McGill Pain Questionnaire showed that ankle‐injured controls had higher initial pain scores than the corresponding whiplash group, while whiplash‐injured subjects had higher scores at 6 months; pain scores being similar at other time points. No difference was found in cold pressor pain between recovered whiplash patients and ankle‐injured subjects. Non‐recovery was only encountered in whiplash injury. Eleven non‐recovered whiplash patients (defined as: handicap after 1 year) showed reduced time to peak pain from 1 week to 3 months ( P < 0.001), 6 months ( P < 0.01), but not 12 months after the injury. A larger pain area was seen in non‐recovered vs. recovered whiplash‐injured subjects during the entire observation period ( P < 0.001). Non‐recovery after whiplash was associated with initially reduced cold pressor pain endurance and increased peak pain, suggesting that dysfunction of central pain modulating control systems plays a role in chronic pain after acute whiplash injury.