Mechanisms of chronic pain from whiplash injury

J Forensic Leg Med. 2013 Feb;20(2):74-85. doi: 10.1016/j.jflm.2012.05.004. Epub 2012 Jul 4.

Abstract

This article is to provide insights into the mechanisms underlying chronic pain from whiplash injury. Studies show that injury produces plasticity changes of different neuronal structures that are responsible for amplification of nociception and exaggerated pain responses. There is consistent evidence for hypersensitivity of the central nervous system to sensory stimulation in chronic pain after whiplash injury. Tissue damage, detected or not by the available diagnostic methods, is probably the main determinant of central hypersensitivity. Different mechanisms underlie and co-exist in the chronic whiplash condition. Spinal cord hyperexcitability in patients with chronic pain after whiplash injury can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain pain in the absence of detectable tissue damage. Whiplash is a heterogeneous condition with some individuals showing features suggestive of neuropathic pain. A predominantly neuropathic pain component is related to a higher pain/disability level.

Publication types

  • Review

MeSH terms

  • Brain Chemistry / physiology
  • Cervical Vertebrae / physiopathology
  • Chemokines / metabolism
  • Chronic Pain / physiopathology*
  • Cytokines / metabolism
  • Electromyography
  • Ganglia, Spinal / injuries
  • Ganglia, Spinal / physiopathology
  • Humans
  • Hypothalamo-Hypophyseal System / physiopathology
  • Intervertebral Disc / injuries
  • Ligaments / injuries
  • Ligaments / physiopathology
  • Mechanoreceptors / physiology
  • Muscle, Skeletal / injuries
  • Muscle, Skeletal / physiopathology
  • Nerve Regeneration / physiology
  • Neurogenic Inflammation / physiopathology
  • Neuroma / etiology
  • Neuroma / physiopathology
  • Neuronal Plasticity / physiology
  • Neurons / physiology
  • Nociceptive Pain / physiopathology
  • Pain, Referred / physiopathology
  • Paresthesia / physiopathology
  • Pituitary-Adrenal System / physiopathology
  • Soft Tissue Injuries / physiopathology
  • Stress, Psychological / etiology
  • Temporomandibular Joint Disorders / physiopathology
  • Whiplash Injuries / physiopathology*
  • Zygapophyseal Joint / physiopathology

Substances

  • Chemokines
  • Cytokines