Five years post whiplash injury: Symptoms and psychological factors in recovered versus non-recovered

<p>Abstract</p> <p>Background</p> <p>Few studies have focused on the differences between persons who are recovered after whiplash injury and those who suffer from persistent disability. The primary aim of this study was therefore to examine differences in symptoms, psychological factors and life satisfaction between subjects classified as recovered and those with persistent disability five years after whiplash injury based on the Neck Disability Index (NDI).</p> <p>Methods</p> <p>A set of questionnaires was answered by 158 persons (75 men, 83 women) to assess disability (NDI), pain intensity (VAS), whiplash-related symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ), post-traumatic stress (Impact of Event Scale, IES), depression (Beck's depression inventory, BDI) and life satisfaction (LiSat-11).</p> <p>The participants were divided into three groups based on the results of the NDI: recovered (34.8%), mild disability (37.3%) and moderate/severe disability (27.3%).</p> <p>Results</p> <p>The moderate/severe group reported significantly higher VAS, BDI and IES scores and lower level of physical health and psychological health compared to the mild and the recovered groups. Less significant differences were reported between the mild and the recovered groups.</p> <p>Conclusions</p> <p>The group with the highest disability score reported most health problems with pain, symptoms, depression, post-traumatic stress and decreased life satisfaction. These findings indicate that classifying these subjects into subgroups based on disability levels makes it possible to optimize the management and treatment after whiplash injury.</p

Who benefits from multimodal rehabilitation &ndash; an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation

Bj&ouml;rn Gerdle,1 Sophia &Aring;kerblom,2,3 Gunilla Brodda Jansen,4 Paul Enthoven,1 Malin Ernberg,5,6 Huan-Ji Dong,1 Britt-Marie St&aring;lnacke,7 Bj&ouml;rn O &Auml;ng,8&ndash;10 Katja Boersma11 1Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Link&ouml;ping University, Link&ouml;ping, Sweden; 2Department of Pain Rehabilitation, Sk&aring;ne University Hospital, Lund, Sweden; 3Department of Psychology, Lund University, Lund, Sweden; 4Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden; 5Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; 6Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden; 7Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Ume&aring; University, Ume&aring;, Sweden; 8Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden; 9Center for Clinical Research Dalarna &ndash; Uppsala University, Falun, Sweden; 10School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; 11School of Law, Psychology and Social Work, &Ouml;rebro University, &Ouml;rebro, Sweden Background: Chronic pain patients frequently suffer from psychological symptoms. There is no consensus concerning the prevalence of severe anxiety and depressive symptoms and the strength of the associations between pain intensity and psychological distress. Although an important aspect of the clinical picture is understanding how the pain condition impacts life, little is known about the relative importance of pain and psychological symptoms for individual&rsquo;s life impact. The aims of this study were to identify subgroups of pain patients; to analyze if pain, psychological distress, and life impact variables influence subgrouping; and to investigate how patients in the subgroups benefit from treatments. Methods: Background variables, pain aspects (intensity/severity and spreading), psychological distress (depressive and anxiety symptoms), and two life impact variables (pain interference and perceived life control) were obtained from the Swedish Quality Registry for Pain Rehabilitation for chronic pain patients and analyzed mainly using advanced multivariate methods. Results: Based on &gt;35,000 patients, 35%&ndash;40% had severe anxiety or depressive symptoms. Severe psychological distress was associated with being born outside Europe (21%&ndash;24% vs 6%&ndash;8% in the category without psychological distress) and low education level (20.7%&ndash;20.8% vs 26%&ndash;27% in the category without psychological distress). Dose relationships existed between the two psychological distress variables and pain aspects, but the explained variances were generally low. Pain intensity/severity and the two psychological distress variables were significantly associated (R2=0.40&ndash;0.48; P&gt;0.001) with the two life impact variables (pain interference and life control). Two subgroups of patients were identified at baseline (subgroup 1: n=15,901&ndash;16,119; subgroup 2: n=20,690&ndash;20,981) and the subgroup with the worst situation regarding all variables participated less in an MMRP (51% vs 58%, P&lt;0.001) but showed the largest improvements in outcomes. Conclusion: The results emphasize the need to assess both pain and psychological distress and not take for granted that pain involves high psychological stress in the individual case. Not all patients benefit from MMRP. A better matching between common clinical pictures and the content of MMRPs may help improve results. We only partly found support for treatment resistance in patients with psychological distress burden. Keywords: anxiety, chronic pain, control, depression, life impact, sociodemographi

One-year follow-up of patients with mild traumatic brain injury : post-concussion symptoms, disabilities and life satisfaction at follow-up in relation to serum levels of S-100B and neuron-specific enolase in acute phase

OBJECTIVE: To investigate, in patients with mild traumatic brain injury, serum concentrations of S-100B and neurone-specific enolase in acute phase and post-concussion symptoms, disabilities and life satisfaction 1 year after the trauma. DESIGN: Prospective study. PATIENTS: Eighty-eight patients (age range 18-87 years). METHODS: Blood samples were taken on admission and about 7 hours later. At follow-up 15 +/- 4 months later, the patients filled in questionnaires about symptoms (Rivermead Post Concussion Symptoms), disability (Rivermead Head Injury Follow-up) and life satisfaction (LiSat-11). RESULTS: Concentrations of S-100B and neurone-specific enolase were regularly increased in the first blood sample. Of the 69 patients participating in the follow-up, 45% reported post-concussion symptom, 48% exhibited disability and 55% were satisfied with "life as a whole". In comparison with the "sick-leave" situation on admission to hospital, 3 patients were on sick-leave at the time of follow-up because of the head trauma. Stepwise forward logistic regression analysis revealed a statistically significant association (p&lt;0.05) between disability and S-100B and dizziness. CONCLUSION: In spite of frequent persistent symptoms, disabilities and low levels of life satisfaction, the sick-leave frequency was low at follow-up. The association between S-100B and disability supports the notion that long-term consequences of a mild brain injury may partly be a result of brain tissue injury

Altered thermal sensitivity in facial skin in chronic whiplash-associated disorders

There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury. Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma. The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders (WADs) with both a qualitative method and quantitative sensory testing (QST). Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women. Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits. Seven test sites in the facial skin (overlying each trigeminal branch bilaterally, and the midpoint of the chin) were examined. The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds. For the WAD patients, the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy, whereas QST systematically showed significantly higher detection thresholds (i.e., decreased sensitivity) for both cold and warm stimuli. For the individuals who were assessed as having increased sensitivity in the qualitative assessment, the QST displayed either normal or higher thresholds, i.e., decreased sensitivity. The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method. The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain

A dynamic model of the head acceleration associated with heading a soccer ball

This study develops a dynamic model of head acceleration, which incorporates physiologically related neck muscle contributions, to further the understanding of the mechanical behaviour of the head-neck system during soccer heading. An inverted pendulum is combined with a linear visco-elastic element to model the head-neck system following a half-sine input force. Model parameter values were varied to obtain agreement with previously published experimental data (Naunheimet al., 2003), and were subsequently compared to literature values. The model predicted the same mechanical angular kinematics as observed experimentally both during and post impact. The greatest acceleration was in the anterior direction at the instant the ball left the head, attributed to the elastic stiffness of the neck musculature. The head-neck stiffness and damping coefficients determined from the model (350 N m rad-1 and 4 N m s rad-1, respectively) were similar to those reported elsewhere when subjects were asked to resist maximally. The model may be subsequently used to investigate differences in technique and ability with respect to the salient model parameters to further our biomechanical understanding of soccer heading