Open AccessDecreased Regional Grey Matter Volume in Women with Chronic Whiplash-Associated Disorders: Relationships with Cognitive Deficits and Disturbed Pain Processing
Author(s) -
Iris Coppieters,
Robby De Pauw,
Karen Caeyenberghs,
Lieven Danneels,
Jeroen Kregel,
Astrid Pattyn,
Mira Meeus,
Barbara Cagnie
Publication year - 2017
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2017.7.e1025
Subject(s) - medicine , whiplash , chronic pain , cognition , neuroimaging , grey matter , anterior cingulate cortex , posterior cingulate , orbitofrontal cortex , magnetic resonance imaging , cingulate cortex , physical therapy , physical medicine and rehabilitation , psychiatry , white matter , poison control , prefrontal cortex , central nervous system , environmental health , radiology
Background: Patients with chronic whiplash-associated disorders (CWAD) are characterized bypain of traumatic origin, cognitive deficits, and central sensitization (CS). Previous neuroimagingstudies revealed altered grey matter volume (GMV) in mild traumatic brain injury patients andchronic pain conditions also characterized by CS. It can therefore be hypothesized that GMValterations also play a role in the persistent complaints of CWAD. However, brain alterations remainpoorly investigated in these patients.Objectives: This study examined regional GMV alterations in patients with CWAD compared topatients with non-traumatic chronic idiopathic neck pain (CINP), who normally do not show CSat a group level, and healthy controls. Additionally, in both patient groups, relationships betweenregional GMV and measures of cognition as well as pain processing were assessed.Study Design: A cross-sectional case-control study.Setting: This study was performed at the Department of Rehabilitation Sciences and Physiotherapyof Ghent University in cooperation with the Ghent Institute for Functional and Metabolic Imaging.Methods: Ninety-three women (28 healthy controls, 34 CINP patients, and 31 CWAD patients)were enrolled. First, T1-weighted magnetic resonance images (MRIs) were acquired to examineGMV alterations in the brain regions involved in processing cognition and pain. Next, cognitiveperformance, pain cognitions, and CS symptoms were assessed. Finally, hyperalgesia andconditioned pain modulation efficacy were examined.Results: Regional GMV of the right lateral orbitofrontal cortex, left supramarginal cortex, andleft posterior cingulate cortex was decreased in CWAD patients compared to healthy controls (P =0.023; P = 0.012; P = 0.047, respectively). Additionally, GMV of the right superior parietal cortexand left posterior cingulate cortex was decreased in CWAD patients compared to CINP patients(P = 0.008; P = 0.035, respectively). Decreased regional GMV correlated with worse cognitiveperformance, higher maladapted pain cognitions, CS symptoms, and hyperalgesia in CWADpatients (rs = -0.515 to -0.657; P < 0.01). In CINP patients, decreased regional GMV correlatedonly with worse cognitive performance (rs = -0.499 to -0.619; P < 0.01), and no GMV differencescompared with the controls could be revealed.Limitations: No conclusions about the causality of the observed relationships can be drawn.Conclusions: These results provide the first evidence for reduced GMV in cortical regionsinvolved in processing cognition and pain in patients with CWAD. Accordingly, it is recommendedthat therapy approaches for CWAD patients should address the brain and take into accountneuroplasticity of the central nervous system (CNS).Key words: Whiplash injuries, neck pain, magnetic resonance imaging, grey matter, cognitivedysfunction, pain catastrophizing, central sensitization