Management of chronic pain in whiplash injury

Abstract

We investigated the response of chronic neck and shoulder pain to decompression of the carpal tunnel in 38 patients with whiplash injury. We also determined the plasma levels of substance P (SP) and calcitonin gene-related peptide (CGRP), which are inflammatory peptides that sensitise nociceptors. Compared with normal control subjects, the mean concentrations of SP (220 v 28 ng/l; p < 0.0001) and CGRP (400 v 85 ng/l; p < 0.0005) were high in patients with chronic shoulder and neck pain before surgery. After operation their levels fell to normal. There was resolution of neurological symptoms with improvement of pain in 90% of patients. Only two of the 30 with chronic neck and shoulder pain who had been treated conservatively showed improvement when followed up at two years.In spite of having neuropathic pain arising from the median nerve, all these patients had normal electromyographic and nerve-conduction studies. Chronic pain in whiplash injury may be caused by 'atypical' carpal tunnel syndrome and responds favourably to surgery which is indicated in patients with neck, shoulder and arm pain but not in those with mild symptoms in the hand. Previously, the presence of persistent neurological symptoms has been accepted as a sign of a poor outcome after a whiplash injury, but our study suggests that it may be possible to treat chronic pain by carpal tunnel decompression.

Plasma Neuropeptides in Patients Undergoing Lumbar Discectomy

“…These include injuries of soft tissue, 19 skin (burns), 13 bone (fractures), 14 and ligament/joint capsule (whiplash). 15 Compared with these reports, changes in plasma levels of CGRP and galanin associated with lumbar discectomy in the present study were smaller. However, they showed statistical significance in paired Student t test and Wilcoxon signed-ranks test.…”

“…Besides their regulatory function in pain signaling, neuropeptides can also serve as the local and systemic neurochemical signature of pain states. 7 Increases in the plasma level of neuropeptides have been reported in patients with a variety of painful conditions, including burns, 13 fractures, 14 whiplash, 15 and headaches. 8 Nevertheless, such available information on LDH has been limited to the analysis of cerebrospinal fluid (CSF), the results of which showed no significant increases of neuropeptide levels in patients with this condition.…”

Fibromyalgia: Progress in diagnosis and treatment

“…For example, four different studies have identified much higher levels of the pro-nociceptive substance P in the cerebrospinal fluid (CSF) of patients with fibromyalgia versus control subjects [17]. Elevated substance P is not specific for fibromyalgia because it occurs in other chronic pain states, such as chronic daily headaches and chronic neck/shoulder pain associated with whiplash injury [18,19].…”

Mechanistic Studies and Their Implication for the Management of Fibromyalgia Syndrome

“…Four different studies have identified much higher levels of the pronociceptive substance P [SP] in the cerebrospinal fluid [CSF] of patients with FMS versus control subjects (19). Elevated SP is not specific for FMS because it occurs in other chronic pain states, such as chronic daily headaches and chronic neck/shoulder pain associated with whiplash injury (20,21). Thus, high SP appears to be a biological marker for the presence of chronic pain.…”