Article

OBJECTIVE: To investigate changes in clinical (physical and psychological)
features of individuals with chronic whiplash-associated disorder who had
previously undergone cervical radiofrequency neurotomy at the time point when the
effects of radiofrequency neurotomy had dissipated and pain returned. DESIGN:
Prospective cohort observational trial of consecutive patients. SETTING: Tertiary
spinal intervention centre in Calgary, Alberta, Canada. PATIENTS: A total of 53
consecutive individuals with chronic whiplash-associated disorder. METHODS:
Individuals underwent radiofrequency neurotomy and were assessed before
radiofrequency neurotomy, at 1 and 3 months postprocedure, and then after the
return of pain (approximately 10 months postprocedure). MAIN OUTCOME MEASUREMENTS: Quantitative sensory tests (pressure; thermal pain thresholds;
brachial plexus provocation test), nociceptive flexion reflex, and motor function
(cervical range of movement; craniocervical flexion test) were measured.
Self-reported disability, psychological distress, pain catastrophization, and
posttraumatic stress disorder symptoms also were measured. RESULTS: Upon the
return of pain after radiofrequency neurotomy, levels of disability increased (P
< .0001), and were no different to those before radiofrequency neurotomy (P =
.99). There also was a significant deterioration in quantitative sensory testing
measures and reduced cervical range of motion after the return of pain (all P <
.05); all approaching values were recorded before radiofrequency neurotomy (P >
.22). There were no significant changes in pressure hyperalgesia (P > .054) or
craniocervical flexion test performance (P > .07) after the return of pain.
Psychological distress and pain catastrophizing increased significantly after the
return of pain (P < .01), and again were no different than measures taken prior
to radiofrequency neurotomy (P > .13). However, there was no difference in number
or severity of posttraumatic stress symptoms after the return of pain (P > .30).
CONCLUSIONS: Physical and psychological features of chronic whiplash-associated
disorder are modulated dynamically with cervical radiofrequency neurotomy. These
findings indicate that peripheral nociception is involved in the manifestations
of chronic whiplash-associated disorder in this cohort of individuals.
CI - Copyright (c) 2015 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc.
All rights reserved.

Langue : ANGLAIS