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Chronic inflammation in whiplash patients: Evidence from [11C]D-deprenyl Positron Emission Tomography
Uppsala University, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Faculty of Social Sciences, Department of Psychology.
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Article in journal (Refereed) Submitted
Identifiers
URN: urn:nbn:se:uu:diva-97752OAI: oai:DiVA.org:uu-97752DiVA: diva2:172808
Available from: 2008-11-12 Created: 2008-11-12Bibliographically 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
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Available from: 2008-11-12 Created: 2008-11-12Bibliographically approved

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