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Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia.

Abstract

Patients with chronic pain after whiplash injury and fibromyalgia patients display exaggerated pain after sensory stimulation. Because evident tissue damage is usually lacking, this exaggerated pain perception could be explained by hyperexcitability of the central nervous system. The nociceptive withdrawal reflex (a spinal reflex) may be used to study the excitability state of spinal cord neurons. We tested the hypothesis that patients with chronic whiplash pain and fibromyalgia display facilitated withdrawal reflex and therefore spinal cord hypersensitivity. Three groups were studied: whiplash (n=27), fibromyalgia (n=22) and healthy controls (n=29). Two types of transcutaneous electrical stimulation of the sural nerve were applied: single stimulus and five repeated stimuli at 2 Hz. Electromyography was recorded from the biceps femoris muscle. The main outcome measurement was the minimum current intensity eliciting a spinal reflex (reflex threshold). Reflex thresholds were significantly lower in the whiplash compared with the control group, after both single (P=0.024) and repeated (P=0.035) stimulation. The same was observed for the fibromyalgia group, after both stimulation modalities (P=0.001 and 0.046, respectively). We provide evidence for spinal cord hyperexcitability in patients with chronic pain after whiplash injury and in fibromyalgia patients. This can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain, at least in part, pain in the absence of detectable tissue damage.

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  • Authors+Show Affiliations

    ,

    Division of Pain Therapy, Department of Anesthesiology, University Hospital of Bern, Inselspital, 3010 Bern, Switzerland.

    , , , , ,

    Source

    Pain 107:1-2 2004 Jan pg 7-15

    MeSH

    Adult
    Chronic Disease
    Electromyography
    Female
    Fibromyalgia
    Humans
    Male
    Middle Aged
    Muscle Contraction
    Pain
    Pain Measurement
    Pain Threshold
    Psychometrics
    Reflex
    Spinal Cord
    Transcutaneous Electric Nerve Stimulation
    Whiplash Injuries

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    14715383

    Citation

    Banic, Borut, et al. "Evidence for Spinal Cord Hypersensitivity in Chronic Pain After Whiplash Injury and in Fibromyalgia." Pain, vol. 107, no. 1-2, 2004, pp. 7-15.
    Banic B, Petersen-Felix S, Andersen OK, et al. Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain. 2004;107(1-2):7-15.
    Banic, B., Petersen-Felix, S., Andersen, O. K., Radanov, B. P., Villiger, P. M., Arendt-Nielsen, L., & Curatolo, M. (2004). Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. Pain, 107(1-2), pp. 7-15.
    Banic B, et al. Evidence for Spinal Cord Hypersensitivity in Chronic Pain After Whiplash Injury and in Fibromyalgia. Pain. 2004;107(1-2):7-15. PubMed PMID: 14715383.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia. AU - Banic,Borut, AU - Petersen-Felix,Steen, AU - Andersen,Ole K, AU - Radanov,Bogdan P, AU - Villiger,P M, AU - Arendt-Nielsen,Lars, AU - Curatolo,Michele, PY - 2004/1/13/pubmed PY - 2004/3/23/medline PY - 2004/1/13/entrez SP - 7 EP - 15 JF - Pain JO - Pain VL - 107 IS - 1-2 N2 - Patients with chronic pain after whiplash injury and fibromyalgia patients display exaggerated pain after sensory stimulation. Because evident tissue damage is usually lacking, this exaggerated pain perception could be explained by hyperexcitability of the central nervous system. The nociceptive withdrawal reflex (a spinal reflex) may be used to study the excitability state of spinal cord neurons. We tested the hypothesis that patients with chronic whiplash pain and fibromyalgia display facilitated withdrawal reflex and therefore spinal cord hypersensitivity. Three groups were studied: whiplash (n=27), fibromyalgia (n=22) and healthy controls (n=29). Two types of transcutaneous electrical stimulation of the sural nerve were applied: single stimulus and five repeated stimuli at 2 Hz. Electromyography was recorded from the biceps femoris muscle. The main outcome measurement was the minimum current intensity eliciting a spinal reflex (reflex threshold). Reflex thresholds were significantly lower in the whiplash compared with the control group, after both single (P=0.024) and repeated (P=0.035) stimulation. The same was observed for the fibromyalgia group, after both stimulation modalities (P=0.001 and 0.046, respectively). We provide evidence for spinal cord hyperexcitability in patients with chronic pain after whiplash injury and in fibromyalgia patients. This can cause exaggerated pain following low intensity nociceptive or innocuous peripheral stimulation. Spinal hypersensitivity may explain, at least in part, pain in the absence of detectable tissue damage. SN - 0304-3959 UR - https://www.unboundmedicine.com/medline/citation/14715383/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0304395903004068 DB - PRIME DP - Unbound Medicine ER -