Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis

被引:11
|
作者
Fundaun, Joel [1 ]
Kolski, Melissa [2 ,3 ]
Baskozos, Georgios [1 ]
Dilley, Andrew [4 ]
Sterling, Michele [5 ]
Schmid, Annina B. [1 ]
机构
[1] Univ Oxford, Nuffield Dept Clin Neurosci, West Wing Level 6, Oxford OX3 9DU, England
[2] Northwestern Univ, Feinberg Sch Med, Dept Phys Therapy & Human Movement Sci, Chicago, IL 60611 USA
[3] Shirley Ryan AbilityLab, Musculoskeletal Outpatient Dept, Chicago, IL USA
[4] Univ Sussex, Brighton & Sussex Med Sch, Brighton, E Sussex, England
[5] Univ Queensland, RECOVER Injury Res Ctr, NHMRC Ctr Res Excellence Recovery Following Rd Tr, Brisbane, Qld, Australia
基金
英国惠康基金;
关键词
Motor vehicle collision; Whiplash-associated disorder; Traumatic neck pain; Neuropathic pain; Neuropathy; MOTOR-VEHICLE ACCIDENTS; QUEBEC TASK-FORCE; SENSORY HYPERSENSITIVITY; PSYCHOLOGICAL-FACTORS; BRACHIAL PLEXOPATHIES; REDEFINING WHIPLASH; FIBER PATHOLOGY; GUNSHOT WOUNDS; FOLLOW-UP; DISORDERS;
D O I
10.1097/j.pain.0000000000002509
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
There is no clear understanding of the mechanisms causing persistent pain in patients with whiplash-associated disorder (WAD). The aim of this systematic review was to assess the evidence for nerve pathology and neuropathic pain in patients with WAD. EMBASE, PubMed, CINAHL (EBSCO), and MEDLINE were searched from inception to September 1, 2020. Study quality and risk of bias were assessed using the Newcastle-Ottawa Quality Assessment Scales. Fifty-four studies reporting on 390,644 patients and 918 controls were included. Clinical questionnaires suggested symptoms of predominant neuropathic characteristic in 34% of patients (range 25%-75%). The mean prevalence of nerve pathology detected with neurological examination was 13% (0%-100%) and 32% (10%-100%) with electrodiagnostic testing. Patients independent of WAD severity (Quebec Task Force grades I-IV) demonstrated significantly impaired sensory detection thresholds of the index finger compared with controls, including mechanical (SMD 0.65 [0.30; 1.00] P < 0.005), current (SMD 0.82 [0.25; 1.39] P = 0.0165), cold (SMD -0.43 [-0.73; -0.13] P = 0.0204), and warm detection (SMD 0.84 [0.25; 1.42] P = 0.0200). Patients with WAD had significantly heightened nerve mechanosensitivity compared with controls on median nerve pressure pain thresholds (SMD -1.10 [-1.50; -0.70], P < 0.0001) and neurodynamic tests (SMD 1.68 [0.92; 2.44], P = 0.0004). Similar sensory dysfunction and nerve mechanosensitivity was seen in WAD grade II, which contradicts its traditional definition of absent nerve involvement. Our findings strongly suggest a subset of patients with WAD demonstrate signs of peripheral nerve pathology and neuropathic pain. Although there was heterogeneity among some studies, typical WAD classifications may need to be reconsidered and include detailed clinical assessments for nerve integrity.
引用
收藏
页码:E789 / E811
页数:23
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