MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C7747F.27EBC560" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C7747F.27EBC560 Content-Location: file:///C:/E67D4A27/WhiplashInjury-DrWong.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Pain after Whiplash Injury

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Chronic Pain after Whiplash Injury
Dr Steven Wong
Department of Anaesthesiology
Queen Elizabeth Hospital
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Whiplash Injury
Terminologies
n<= /span>Whiplash &= #13;
•First coin= ed in 1928 by HE Crowe
<= span style=3D'font-size:86%'>•Describes = the lashlike effects of sudden acceleration-decelerati= on forces on the neck and upper trunk due to external forces
nWhiplash-Associated Disorders (WAD)
<= span style=3D'font-size:86%'>•Defined in= 1995 by the Quebec Task Force on WAD <= /div>
<= span style=3D'font-size:86%'>•Describes = a wide variety of clinical manifestations resulting from whiplash injury<= /span>
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file:///C:/E67D4A27/WhiplashInjury-DrWong_files/slide0008.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Pain after Whiplash Injury
Whiplash Associated Disorders = = (WAD)
nGrade 1:
&= #8226;Injury and symptoms: = ;
nProbable muscle sprain
nNeck stiffness only
&= #8226;Signs:
nNo tenderness and normal= range of motion
nNormal reflexes and muscle strength in the limbs
------=_NextPart_01C7747F.27EBC560 Content-Location: file:///C:/E67D4A27/WhiplashInjury-DrWong_files/slide0009.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Pain after Whiplash Injury
Whiplash Associated Disorders = = (WAD)
nGrade 2:
•Injury and symptoms:
nProbable muscle and /or ligament sprain
nAny combination of neck pain with /wi= thout back pain, jaw pain, jaw locking, jaw clicking, limb numbness, dizziness
•Signs:
nParaspinal tenderness and restricted = spine range of motion
nNormal reflexes and muscle strength i= n the limbs =
n<= span lang=3DEN-US style=3D'font-family:\65B0\7D30\660E\9AD4;mso-fareast-font-fa= mily: \65B0\7D30\660E\9AD4;mso-fareast-language:ZH-TW;mso-special-format:lastCR; display:none'>
------=_NextPart_01C7747F.27EBC560 Content-Location: file:///C:/E67D4A27/WhiplashInjury-DrWong_files/slide0010.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Pain after Whiplash Injury
Whiplash Associated Disorders = = (WAD)
nGrade 3:
•Injury and symptoms:
nProbable disc protrusion with nerve r= oot impingement <= /span>
nNeck pain, often arm pain or numbness=
•Signs:
nAbnormal reflexes and /or muscle weak= ness, often with sensory chang= es in a dermatomal pattern suggesting nerve root impingement (typically due to disc protrusion)= 3;
•
------=_NextPart_01C7747F.27EBC560 Content-Location: file:///C:/E67D4A27/WhiplashInjury-DrWong_files/slide0011.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Pain after Whiplash Injury
Whiplash Associated Disorders = = (WAD)
nGrade 4:
•Injury and symptoms:
nCervical fracture and / or dislocatio= n
nNeck pain, possible neurological symp= toms in limbs, urinary incont= inence due to spinal cord involvement
•Signs:
nPossible hyperreflexia, positive Babi= nski’s sign, motor weakness and= sensory changes suggesting spinal cord injury
nRadiograph reveals fracture and / or = dislocation
------=_NextPart_01C7747F.27EBC560 Content-Location: file:///C:/E67D4A27/WhiplashInjury-DrWong_files/slide0013.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Pain after Whiplash Injury
Epidemiology of WAD
nAt 6 months after injury:
Partheni et al, 2000
Patras, <= span style=3D'position:absolute;top:63.74%;left:52.62%;width:17.79%;height:4.75= %'>Greece
180
1
353
117
210
Number of <= /span>
Patients (n)
Brison et al, 2000
Kingston, Canada
35
Radanov et al, 1995
Berne, Switzerlan= d
30
Oblieniene et al, 199= 9
Kaunas, <= span style=3D'position:absolute;top:52.25%;left:52.62%;width:17.79%;height:4.75= %'>Lithuania =
0
Authors / Date
City / Country=
Incidence <= /span>
(%)
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Epidemiology of WAD
nAt 1 year after injury:
Gargan & Bannister,= 1990
Bristol & Oxford, UK=
43
28
353
117
210
Number of <= /span>
Patients (n)
Brison et al, 2000
Kingston, Canada
34
Radanov et al, 1995
Berne, Switzerlan= d
24
Oblieniene et al, 199= 9
Kaunas, <= span style=3D'position:absolute;top:53.25%;left:52.62%;width:17.79%;height:4.75= %'>Lithuania =
4
Authors / Date
City / Country=
Incidence <= /span>
(%)
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Epidemiology of WAD
nAt 2 years after injury:
Gargan & Bannister,= 1990
Bristol & Oxford, UK=
43
32
353
117
Number of <= /span>
Patients (n)
Brison et al, 2000
Kingston, Canada
35
Radanov et al, 1995
Berne, Switzerlan= d
18
Authors / Date
City / Country=
Incidence <= /span>
(%)
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Epidemiology of WAD
nAt >2 years after injury:
Berglund et al, 2000
Sweden
232
40
(at 7 years)
43
Number of <= /span>
Patients (n)
Gargan & Bannister,= 1990
Bristol & Oxford, UK=
30
(at 10 years)
Authors / Date
City / Country=
Incidence <= /span>
(%)
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What is causing the pain?
nCervical <= /span>zygopophys= ial joint identified as the source of pain by diagnostic= block in up to 80% of patients in whiplash injury (Lord e= t al, 1996)
nBiomechanic studies
<= span style=3D'font-size:86%'>nWide variation in epidemiolo= gy
nInconsistent relation between sy= mptoms and degree= of injury
<= span style=3D'font-size:86%'>nRare in car-crash contests&#= 13;
nIncidence likely linked to = systems of reporting and compensation (Schrader et al, 199= 6)
Archives of Neurology 2000;57:pp590-4
FUNCTIONAL
ORGANI= C
vs
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Biomechanic studies
Grauer et al. Spine 1997;22:2489-94
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Biomechanic studies
<= span style=3D'font-size:88%'>nDuring rear impact, the lower cervical = vertebrae = are forced into hyperextension while the upper ones are in rel= ative flexion resulting in a S-shape curve (Grauer= et al. Spine 1997;22:2489-94)
<= span style=3D'font-size:88%'>nImpingement of cervical zygopophysial <= /span>joint and stretching of anterior longitudinal ligament demonstrated by motion analysis of deformation of cervical s= pine during rear-end collision (Kaneoka et al, 1999= )
------=_NextPart_01C7747F.27EBC560 Content-Location: file:///C:/E67D4A27/WhiplashInjury-DrWong_files/slide0006.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Pain after Whiplash Injury
Why does the pain become chronic?
nPost-inju= ry sensitization
nPsychosoc= ial factors
------=_NextPart_01C7747F.27EBC560 Content-Location: file:///C:/E67D4A27/WhiplashInjury-DrWong_files/slide0020.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Pain after Whiplash Injury
Post-injury sensitization
nTissue trauma leads to reversible increase in excitability of the nociceptive system <= /span>
nPatients after whiplash injury had lower pain threshold than healthy subjects (Curatolo et al, 2001)
<= span style=3D'visibility:hidden'>n =
<= span style=3D'visibility:hidden'>n
------=_NextPart_01C7747F.27EBC560 Content-Location: file:///C:/E67D4A27/WhiplashInjury-DrWong_files/slide0012.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Pain after Whiplash Injury
Biopsychosocial model of pain in WAD
Minor = physica= l = injury<= /b>
= Chronic=
pain
Anger
Fright
Symptom amplification
= Anxiety wh= ile
driving
Expecta= tion of chronic pain
Media
Culture fa= shion
Rumour
Frightening diagnosis
= Failure of multiple therapies
aiming at = physical injury
Lack of reassurance
Poor postu= re
Frightening prognosis
Symptom amplification
= Battles wi= th insurance
company
Symptom attribution
Ferrari, 2002