The arms and legs can exhibit alterations in their sensory reactions even though those regions have no reported symptoms, in response to a neck pain problem or a neck injury. If the area being tested exhibits an abnormally elevated pain response to a stimulus which would be typically painful anyhow this is termed hyperalgesia. Hyperalgesia may be caused by an increased response to incoming feelings within the local nerve systems in the neck. However, if the abnormalities of feeling are more extensive then the central nervous system is more likely to be processing abnormally. Whiplash patients may exhibit the more widespread symptoms.
Patients suffering from whiplash associated disorder report increased levels of disability and neck pain and have more widespread pain on manual examination. There are typical changes which occur in the processes by which pain is processed in the central nervous system which are shared by both whiplash patients and those with nerve root lesions in the cervical spine. A pain condition called allodynia may also present, which is a pain reaction defined by being a painful response to a normally non-painful stimulus. Allodynia also gives a clue that central nervous systems are involved in the process.
At the time of the injury the abnormal pain processing mechanisms are set up in the nervous system and the same abnormalities have been shown to be present in patients with chronic whiplash pain. Whatever the severity of the whiplash injury, all sufferers seem to have some degree of pain overreaction to inputs, with this typically settling down in two or three months in less severe cases. Those patients who suffer from chronic neck symptoms and increased levels of pain will also likely have continuing mechanical overreaction which may persist rather than reduce with time. The levels of mental distress also affect pain thresholds.
Psychological distress is commonly present in patients who have whiplash associated disorder and if a patient has higher levels of pain and disability they are also likely to have elevated amounts of mental distress. The increased pain sensitivity that patients exhibit is not thought to be the result of psychological distress but the underlying pain reaction mechanisms in the central nervous system might be responsible for both the hyperalgesia and the psychological distress. Along with these findings, cold hyperalgesia (an increased pain reaction to cold) and abnormalities of circulatory function can occur.
This cold overreaction is a part of the normal injury symptoms if one of the peripheral nerves is damaged and this may support the idea that whiplash injury includes some elements of nerve injury. If there is a nerve root injury in the cervical spine then a cold overreaction response can also be present, possibly linking the underlying pain mechanisms of this pathology with that of whiplash. Neuropathic pains (from abnormal processing in the nervous system) such as burning pain in the neck, sudden pains like electric shocks and cold overreaction have been found in patients with acute whiplash.
Many of the sensory findings in the neck may not easily translate into ways of managing whiplash by physiotherapy. However, if there is only local hyperalgesia in response to mechanical inputs and no other sensory abnormalities, then the local neck structures may be oversensitive due to the injury to the neck tissues. This kind of local abnormality has been shown to react favourably to physiotherapy or other manual therapies. Exercise may also reduce this type of increased nerve reactions and also improves the ways the muscles coordinate, improving the management of neck pain.
If someone has the extra features of neuropathic pain, the overreaction to cold, allodynia and more widespread sensitivity then treatment will have to be much more carefully planned. If the pain is stirred up by treatment this may increase the sensory abnormalities present and make the overall problem worse. More gentle manual and manipulative techniques may be more appropriate in these cases and physiotherapy has been shown to have some effectiveness in managing patients with whiplash.
The presence of the neuropathic symptoms such as overreacting to cold inputs means that there are typically much higher levels of disability and pain and the likelihood of physiotherapy being an effective management is uncertain. Medication for these pains is useful for about 30 percent of patients. - 14130
Patients suffering from whiplash associated disorder report increased levels of disability and neck pain and have more widespread pain on manual examination. There are typical changes which occur in the processes by which pain is processed in the central nervous system which are shared by both whiplash patients and those with nerve root lesions in the cervical spine. A pain condition called allodynia may also present, which is a pain reaction defined by being a painful response to a normally non-painful stimulus. Allodynia also gives a clue that central nervous systems are involved in the process.
At the time of the injury the abnormal pain processing mechanisms are set up in the nervous system and the same abnormalities have been shown to be present in patients with chronic whiplash pain. Whatever the severity of the whiplash injury, all sufferers seem to have some degree of pain overreaction to inputs, with this typically settling down in two or three months in less severe cases. Those patients who suffer from chronic neck symptoms and increased levels of pain will also likely have continuing mechanical overreaction which may persist rather than reduce with time. The levels of mental distress also affect pain thresholds.
Psychological distress is commonly present in patients who have whiplash associated disorder and if a patient has higher levels of pain and disability they are also likely to have elevated amounts of mental distress. The increased pain sensitivity that patients exhibit is not thought to be the result of psychological distress but the underlying pain reaction mechanisms in the central nervous system might be responsible for both the hyperalgesia and the psychological distress. Along with these findings, cold hyperalgesia (an increased pain reaction to cold) and abnormalities of circulatory function can occur.
This cold overreaction is a part of the normal injury symptoms if one of the peripheral nerves is damaged and this may support the idea that whiplash injury includes some elements of nerve injury. If there is a nerve root injury in the cervical spine then a cold overreaction response can also be present, possibly linking the underlying pain mechanisms of this pathology with that of whiplash. Neuropathic pains (from abnormal processing in the nervous system) such as burning pain in the neck, sudden pains like electric shocks and cold overreaction have been found in patients with acute whiplash.
Many of the sensory findings in the neck may not easily translate into ways of managing whiplash by physiotherapy. However, if there is only local hyperalgesia in response to mechanical inputs and no other sensory abnormalities, then the local neck structures may be oversensitive due to the injury to the neck tissues. This kind of local abnormality has been shown to react favourably to physiotherapy or other manual therapies. Exercise may also reduce this type of increased nerve reactions and also improves the ways the muscles coordinate, improving the management of neck pain.
If someone has the extra features of neuropathic pain, the overreaction to cold, allodynia and more widespread sensitivity then treatment will have to be much more carefully planned. If the pain is stirred up by treatment this may increase the sensory abnormalities present and make the overall problem worse. More gentle manual and manipulative techniques may be more appropriate in these cases and physiotherapy has been shown to have some effectiveness in managing patients with whiplash.
The presence of the neuropathic symptoms such as overreacting to cold inputs means that there are typically much higher levels of disability and pain and the likelihood of physiotherapy being an effective management is uncertain. Medication for these pains is useful for about 30 percent of patients. - 14130
About the Author:
Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in bradford visit his website.
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