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Chronic whiplash symptoms are related to altered regional cerebral blood flow in the resting state
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Section of Nuclear Medicine and PET.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
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2009 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 13, no 1, 65-70 p.Article in journal (Refereed) Published
Abstract [en]

The neural pathogenic mechanisms involved in mediating chronic pain and whiplash associated disorders (WAD) after rear impact car collisions are largely unknown. This study's first objective was to compare resting state regional cerebral blood flow (rCBF) by means of positron emission tomography with (15)O labelled water in 21 WAD patients with 18 healthy, pain-free controls. A second objective was to investigate the relations between brain areas with altered rCBF to pain experience, somatic symptoms, posttraumatic stress symptoms and personality traits in the patient group. Patients had heightened resting rCBF bilaterally in the posterior parahippocampal and the posterior cingulate gyri, in the right thalamus and the right medial prefrontal gyrus as well as lowered tempero-occipital blood flow compared with healthy controls. The altered rCBF in the patient group was correlated to neck disability ratings. We thus suggest an involvement of the posterior cingulate, parahippocampal and medial prefrontal gyri in WAD and speculate that alterations in the resting state are linked to an increased self-relevant evaluation of pain and stress.

Place, publisher, year, edition, pages
2009. Vol. 13, no 1, 65-70 p.
Keyword [en]
Whiplash, Positron emission tomography, Neuroimaging, Chronic pain, Post traumatic stress
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-97750DOI: 10.1016/j.ejpain.2008.03.001ISI: 000263012500011PubMedID: 18486506OAI: oai:DiVA.org:uu-97750DiVA: diva2:172806
Available from: 2008-11-12 Created: 2008-11-12 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Imaging Chronic Pain and Inflammation: Positron Emission Tomography Studies of Whiplash Associated Disorder
Open this publication in new window or tab >>Imaging Chronic Pain and Inflammation: Positron Emission Tomography Studies of Whiplash Associated Disorder
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is on chronic neck pain after a rear impact car injury, so called whiplash associated disorder (WAD). Three empirical studies using positron emission tomography (PET) with different radioligands have been performed.

The first study evaluated resting state regional cerebral blood flow (rCBF) in WAD patients and in healthy, pain-free controls, by use of oxygen-15 labeled water. Patients had heightened resting rCBF bilaterally in the posterior parahippocampal and the posterior cingulate gyri, in the right thalamus and in the right medial prefrontal gyrus. Attenuated tempero-occipital blood flow was also observed in the patient group as compared to healthy controls. Alterations in rCBF were related to patients’ neck disability ratings. Study I suggests an involvement of the posterior cingulate, the parahippocampal and the medial prefrontal gyri in WAD. This altered resting state neural activity may be linked to an increased self-relevant evaluation of pain and stress.

The second study evaluated central expression of the neurokinin-1 (NK1) receptor in WAD patients and healthy controls. Using a carbon-11 labeled specific NK1 antagonist, the receptor availability was measured. Patients displayed lowered NK1 receptor availability in the insula, anterior cingulate, frontal lobe, hippocampus, amygdala and in the periaqueductal gray matter, consistent with results from animal models of chronic pain. NK1 receptor availability was most reduced in the ventromedial orbitofrontal cortex, where attenuations were linearly related to patients fear and avoidance of movement.

Thirdly, carbon-11 labeled D-deprenyl was used to investigate the presence of locally inflamed soft tissue in the cervical neck in WAD patients. Although the retention mechanism of [11C]D-deprenyl is not known, the results suggest that WAD patients have chronic inflammatory processes in the neck, most commonly in the adipose tissue at the spineous process of the second vertebra.

In summary, this thesis provides evidence for altered central blood flow and receptor characteristics in WAD patients. Further, WAD patients may also have signs of persistent peripheral tissue damage. Both central and peripheral pain mechanisms have been demonstrated and visualized in patients with whiplash associated disorder.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 90 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 46
Keyword
Whiplash Associated Disorder, PET, brain, chronic pain, rCBF, neurokinin-1, Substance P, inflammation, D-deprenyl, fear of movement, kinesiophobia,
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-9363 (URN)978-91-554-7331-0 (ISBN)
Public defence
2008-12-03, Sal IX, Universitetshuset, Uppsala, 13:15
Opponent
Supervisors
Available from: 2008-11-12 Created: 2008-11-12Bibliographically approved

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Appel, LieuweFrans, ÖrjanFurmark, TomasFredrikson, Mats

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