Whiplash describes an injury to the neck caused by a rapid movement of the head. It often occurs during a motor vehicle collision, causing considerable pain and distress. Most patients are diagnosed with whiplash associated disorder grade-2 (WAD2). Half of these patients develop chronic pain. Current treatments for patients are ineffective. It is difficult to predict which patients will develop chronic pain, and therefore how to manage these patients. The characteristics of pain felt by many patients with WAD2 suggests that symptoms are caused by an injury to the nerves in the neck and arm. However, on clinical examination there is no indication that these nerves are significantly injured. Work from the investigators' laboratory suggests that nerves may be inflamed. In this study, the contribution of nerve inflammation to symptoms early following whiplash will be established. It will determine whether clinical tests are able to identify those patients with inflamed nerves. It will also determine whether the presence of nerve inflammation can be used to identify patients who develop chronic pain. The study will recruit 115 patients within one month following a whiplash injury and thirty-two healthy volunteers. Participants will undergo a clinical assessment. A blood sample will be taken to look for inflammatory proteins and magnetic resonance imaging will be used to identify nerve inflammation in the neck and wrist. Questionnaires to establish neck disability, pain quality and psychological distress will be completed. MRI findings will be compared to healthy controls. At six-months, patients will be asked to repeat the questionnaires, which will be used to identify those patients who have recovered. Twenty-five recovered and twenty-five non-recovered patients will undergo a repeat MRI and clinical assessment. Although patients on this study will not directly benefit, the findings will help with early diagnosis and could refocus treatment to reduce chronic pain.
Study Type
OBSERVATIONAL
Enrollment
147
T2 weighted and DTI MRI images of brachial plexus and wrist. Quantitative sensory tests include warm and cold detection and pain thresholds, paradoxical heat sensation, mechanical detection thresholds, mechanical pain sensation and thresholds, wind up ratios, vibration thresholds and pressure pain thresholds. Clinical tests include standard neurological tests and test for heightened nerve mechanosensitivity. Blood serum to analyse inflammatory proteins. Questionnaires include neck disability index, painDETECT, PTSD8, pain catastrophising scale, eq-5D-5L, DASS 42 and global perceived recovery
Brighton and Sussex Medical School
Brighton, East Sussex, United Kingdom
RECRUITINGOxford Neuroscience, University of Oxford
Oxford, Oxfordshire, United Kingdom
RECRUITINGMRI T2-weighted nerve signal strength
T2-weighted nerve signal strength in the brachial plexus and median nerve compared to healthy control group
Time frame: Baseline
Change in MRI T2-weighted nerve signal strength
Change in T2-weighted nerve signal strength in the brachial plexus and median nerve at 6 months compared to baseline
Time frame: From baseline to 6 months
Fractional anisotropy from diffusion tensor images
Fractional anisotropy measurements from brachial plexus and median nerve compared to healthy controls
Time frame: Baseline
Change in fractional anisotropy from Diffusion tensor images
Fractional anisotropy from brachial plexus and median nerve compared to baseline
Time frame: From baseline to 6 months
T1 MRI median nerve morphology
ratio/mm2; continuous data
Time frame: Baseline
Changes to T1 MRI median nerve morphology
ratio/mm2; continuous data
Time frame: From baseline to 6 months
Pro-inflammatory cytokine levels
Proinflammatory cytokine assay (pg/ml) continuous data
Time frame: Baseline
Change in Pro-inflammatory cytokine levels
Proinflammatory cytokine assay (pg/ml) continuous data
Time frame: From baseline to 6 months
Tests for heightened nerve mechanosensitivity- upper limb neurodynamic test (median nerve)
Measures heightened response to tensile load applied to the nerve. Range of elbow extension at point of symptoms (degrees)
Time frame: Baseline
Change to tests for heightened nerve mechanosensitivity- upper limb neurodynamic test (median nerve)
Measures heightened response to tensile load applied to the nerve. Range of elbow extension at point of symptoms (degrees)
Time frame: From baseline to 6 months
Tests for heightened nerve mechanosensitivity- Pressure pain threshold
Algometer applied to ulnar nerve at the cubital tunnel and median nerve at carpal tunnel. Pressure pain threshold (Kg) at point of change from pressure to pain.
Time frame: Baseline
Change in heightened nerve mechanosensitivity- Pressure pain threshold
Algometer applied to ulnar nerve at the cubital tunnel and median nerve at carpal tunnel. Pressure pain threshold (Kg) at point of change from pressure to pain.
Time frame: From baseline to 6 months
Quantitative sensory testing- warm and cold pain thresholds
Thresholds measured over index finger using a thermotester- continuous data measured in degrees Celsius (point at which the probe changes to warm pain or cold pain)
Time frame: Baseline
Change to Quantitative sensory testing- warm and cold pain thresholds
Thresholds measured over index finger using a thermotester- continuous measured in degrees Celsius (point at which the probe changes to warm pain or cold pain)
Time frame: From baseline to 6 months
Quantitative sensory testing- Mechanical pain threshold
Thresholds measured over index finger using a series of weighted pin prick stimulators (mN). Participant scores pain from 0-100 for each stimulus applied. Geometric mean calculated
Time frame: Baseline
Change in Quantitative sensory testing- Mechanical pain threshold
Thresholds measured over index finger using a series of weighted pin prick stimulators (mN). Participant scores pain from 0-100 for each stimulus applied. Geometric mean calculated
Time frame: From baseline to 6 months
Quantitative sensory testing- Pressure pain threshold
Thresholds measured over thenar eminance using an algometer (Kg). Pressure applied and participant indicates when pressure changes to pain (mean of 3)
Time frame: Baseline
Change in quantitative sensory testing- Pressure pain threshold
Thresholds measured over thenar eminance using an algometer (Kg). Pressure applied and participant indicates when pressure changes to pain (mean of 3)
Time frame: From baseline to 6 months
Changes in Pain levels on Visual analogue scale
Participant indicated pain level on a 10cm scale of 0-10
Time frame: From baseline to 6 months
Change in Neck disability index
Neck disability index. Scale -10 questions each scored 0-5. Total score /50
Time frame: From baseline to 6 months
Change in painDETECT questionnaire
A measure of neuropathic pain. A continuous scale: 0-38 or trichotomised: no, unclear, yes. A score of \>19 suggests neuropathic pain.
Time frame: From baseline to 6 months
Change in Short post-traumatic stress inventory
A measure of post traumatic stress - 8 questions scale of 0-3
Time frame: From baseline to 6 months
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