Background & Aims

Distinct developmental trajectories for neck disability after whiplash injury have been identified [1,2,3]. Their relationship to cold and mechanical sensitivity trajectories is not known. This study aimed to: (i) identify recovery trajectories of cold and mechanical sensitivity, (ii) explore their dual development with disability trajectories, (iii) identify predictors of sensitivity trajectories, and (iv) explore dual development of cold and mechanical sensitivity trajectories.

Methods

233 participants were assessed at <1 month, 3-, 6- and 12-months post whiplash injury. Outcomes were cold pain threshold at the neck (CPT), pressure pain thresholds (PPT) at the neck (C5) and at tibialis anterior (TA) and the Neck Disability Index. Group-based trajectory analytical techniques were used to identify distinct post-injury profiles. Multinominal logistic regression modelling identified baseline factors associated with membership of different trajectories.

Results

Distinct sensitivity trajectories were identified: CPT (low [50.0%], moderate [29.7%], high [20.4%] sensitivity); PPT C5 (low [10.8%], high [89.2%] sensitivity); PPT TA (low [23.9%], moderate [39.0%], high [37.1%] sensitivity). All were stable over the 12 months. There was good correspondence of disability trajectory groups and cold sensitivity but not for mechanical sensitivity. Cold and mechanical sensitivity trajectories were not well aligned. Higher baseline pain predicted the high cold sensitivity trajectory (RR 1.27, 95% CI 1.01-1.59) and hyperarousal symptoms predicted the moderate cold sensitivity trajectory (RR 1.17, 95% CI 1.01-1.36). There were no predictors of mechanical sensitivity trajectories.

Conclusions

There is an interplay between cold allodynia, pain and hyperarousal symptoms in development of ongoing disability after whiplash injury. Different mechanisms likely underlie cold and mechanical sensitivity.

References

[1] Sterling, M., J. Hendrikz and J. Kenardy (2010). “Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: A prospective study.” Pain 150(1): 22-28.
[2] Sterling, M., J. Hendrikz and J. Kenardy (2011). “Similar factors predict disability and PTSD trajectories following whiplash injury.” Pain 152(6): 1272-1278.
[3] Casey, P. P., A. M. Feyer and I. D. Cameron (2015). “Course of recovery for whiplash associated disorders in a compensation setting.” Injury 46(11): 2118-2129.

Presenting Author

Michele Sterling

Poster Authors

Michele Sterling

PhD

RECOVER Injury Research Centre, The University of Queensland, Queensland, Australia

Lead Author

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Scott Farrell

Lead Author

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Nigel Armfield PhD

Lead Author

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Eythor Kristjansson PhD

Lead Author

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Ken Niere PhD

Lead Author

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Steffan Wittrup McPhee Christensen PhD

Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark

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Topics

  • Specific Pain Conditions/Pain in Specific Populations: Neck Pain