Modulation of Cervical Facet Joint Nociception and Pain Attenuates Physical and Psychological Features of Chronic Whiplash: A Prospective Study

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Smith, Ashley Dean
Jull, Gwendolen
Schneider, Geoff M
Frizzell, Bevan
Hooper, Robert A
Sterling, Michele
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Objective: To investigate changes in clinical (physical and psychological) features of individuals with chronic whiplash−associated disorder who had previously undergone cervical radiofrequency neurotomy at the time point when the effects of radiofrequency neurotomy had dissipated and pain returned.

Design: Prospective cohort observational trial of consecutive patients.

Setting: Tertiary spinal intervention centre in Calgary, Alberta, Canada.

Patients: A total of 53 consecutive individuals with chronic whiplash−associated disorder.

Methods: Individuals underwent radiofrequency neurotomy and were assessed before radiofrequency neurotomy; at 1 and 3 months postprocedure, and then after the return of pain (approximately 10 months postprocedure).

Main Outcome Measurements: Quantitative sensory tests (pressure; thermal pain thresholds; brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement; craniocervical flexion test) were measured. Self-reported disability, psychological distress, pain catastrophization, and posttraumatic stress disorder symptoms also were measured.

Results: Upon the return of pain after radiofrequency neurotomy, levels of disability increased (P < .0001), and were no different to those before radiofrequency neurotomy (P = .99). There also was a significant deterioration in quantitative sensory testing measures and reduced cervical range of motion after the return of pain (all P < .05); all approaching values were recorded before radiofrequency neurotomy (P > .22). There were no significant changes in pressure hyperalgesia (P > .054) or craniocervical flexion test performance (P > .07), after the return of pain. Psychological distress and pain catastrophizing increased significantly after the return of pain (P < .01), and again were no different than measures taken prior to radiofrequency neurotomy (P > .13). However, there was no difference in number or severity of posttraumatic stress symptoms after the return of pain (P > .30).

Conclusions: Physical and psychological features of chronic whiplash−associated disorder are modulated dynamically with cervical radiofrequency neurotomy. These findings indicate that peripheral nociception is involved in the manifestations of chronic whiplash−associated disorder in this cohort of individuals.

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Physical Medicine and Rehabilitation (PM & R)
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