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Chronic neck pain: An epidemiological, psychological and SPECT study with emphasis on whiplash-associated disorders
Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic neck pain, a common cause of disability, seems to be the result of several interacting mechanisms. In addition to degenerative and inflammatory changes and trauma, psychological and psychosocial factors are also involved. One common type of trauma associated with chronic neck pain is whiplash injury; this sometimes results in whiplash-associated disorder (WAD), a controversial condition with largely unknown pathogenetic mechanisms. We studied the prevalence of chronic neck pain of traumatic and non-traumatic origin and compared the prevalence of, sociodemographic data, self-perceived health, workload and chronic lowback pain in these groups. In a ready-made questionnaire (MONICA study), we added questions about cervical spine and low-back complaints. 6,000 (72%) completed a self-administered questionnaire. 43% reported neck pain: 48% of women and 38% of men. Women of working age had more neck pain than retired women, a phenomenon not seen in men. 19% of the studied population suffered from chronic neck pain and it was more frequent in women. A history of neck trauma was common in those with chronic neck pain. Those with a history of neck trauma perceived their health worse and were more often on sick-leave. About 50% of those with traumatic and non-traumatic chronic neck pain also had chronic low-back pain.

We assessed the subjective and objective neuropsychological functioning in 42 patients with chronic neck pain, 21 with a whiplash trauma, and 21 without previous neck trauma. Despite cognitive complaints, the WAD patients had normal neuropsychological functioning, but the WAD group especially had deviant MMPI results—indicating impaired coping ability and somatization.WAD patients had no alterations in cerebral blood-flow pattern, as measured by rCBF-SPECT and SPM analysis, compared to healthy controls. This contrasts with the non-traumatic group with chronic neck pain, which showed marked blood-flow changes. The blood-flow changes in the non-traumatic group were similar to those described earlier in pain patients but— remarkably enough—were different from those in the WAD group. Chronic neck pain of whiplash and non-traumatic origin appears to be unique in some respects. A better understanding of the underlying pathological mechanisms is a prerequisite for prevention of the development of such chronic pain syndromes and for improvement of the treatment of patients with severe symptoms.

Place, publisher, year, edition, pages
Umeå: Kirurgisk och perioperativ vetenskap , 2006. , 33 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 0346
Keyword [en]
Prevalence of chronic neck pain, chronic low-back pain, whiplash, WAD, neuropsychology
National Category
Clinical Science
Identifiers
URN: urn:nbn:se:umu:diva-666ISBN: 91-7305-827-0 (print)OAI: oai:DiVA.org:umu-666DiVA: diva2:144173
Public defence
2006-01-27, Sal B, 1D,Tandläkarhögskolan, Norrlands universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2005-12-28 Created: 2005-12-28 Last updated: 2009-10-06Bibliographically approved
List of papers
1. The prevalence of neck pain: A population-based study from northern Sweden
Open this publication in new window or tab >>The prevalence of neck pain: A population-based study from northern Sweden
2002 (English)In: Acta Orthopaedica Scandinavica, ISSN 0001-6470, Vol. 73, no 4, 455-459 p.Article in journal (Refereed) Published
Abstract [en]

The two northernmost counties in Sweden form together 1 of the 39 collaborating centers in the World Health Organization (WHO) MONICA (MONItoring of trends and determinants in CArdiovascular disease) project. At the last survey in 1999, we added some questions about cervical spine complaints. Persons randomly selected from the population in a geographically well-defined area completed a self-administered questionnaire. The sample included 8,356 subjects and 6,000 (72%) of them answered. 43% of the population reported neck pain, more women (48%) than men (38%). Women of working age had more neck pain than older ones, a phenomenon not seen among men. Chronic neck pain, defined as continuous pain of more than 6 months' duration, was commoner in women (22%) than men (16%).More than one fourth of the cases with chronic symptoms had a history of neck or head trauma and one third of these had sustained a whiplash type of injury. Thus, all types of neck trauma seem to be associated with chronic neck pain.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4893 (URN)10.1080/00016470216329 (DOI)12358121 (PubMedID)
Available from: 2005-12-28 Created: 2005-12-28 Last updated: 2012-09-05Bibliographically approved
2. Chronic neck pain of traumatic and nontraumatic origin: A population based study
Open this publication in new window or tab >>Chronic neck pain of traumatic and nontraumatic origin: A population based study
2003 (English)In: Acta Orthopaedica Scandinavica, ISSN 0001-6470, Vol. 74, no 5, 576-579 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-4894 (URN)10.1080/00016470310017983 (DOI)
Available from: 2005-12-28 Created: 2005-12-28 Last updated: 2009-10-06
3. Chronic low back pain in individuals with chronic neck pain of traumatic and non-traumatic origin: a population-based study.
Open this publication in new window or tab >>Chronic low back pain in individuals with chronic neck pain of traumatic and non-traumatic origin: a population-based study.
2006 (English)In: Acta Orthopaedica, ISSN 1745-3674, Vol. 77, no 1, 132-137 p.Article in journal (Refereed) Published
Keyword
Adult, Age Factors, Chronic Disease, Confounding Factors (Epidemiology), Female, Humans, Low Back Pain/*epidemiology/etiology, Male, Neck Pain/*epidemiology/etiology, Prevalence, Questionnaires, Sex Factors, Socioeconomic Factors, Sweden/epidemiology, Whiplash Injuries/*complications
Identifiers
urn:nbn:se:umu:diva-15333 (URN)doi:10.1080/17453670610045812 (DOI)16534713 (PubMedID)
Available from: 2007-07-04 Created: 2007-07-04 Last updated: 2009-10-06Bibliographically approved
4. Neuropsychological functioning and MMPI-2 profiles in chronic neck pain: a comparison of whiplash and non-traumatic groups.
Open this publication in new window or tab >>Neuropsychological functioning and MMPI-2 profiles in chronic neck pain: a comparison of whiplash and non-traumatic groups.
Show others...
2005 (English)In: Journal of Clinical and Experimental Neuropsychology, ISSN 1380-3395, Vol. 27, no 2, 151-163 p.Article in journal (Refereed) Published
Keyword
Adult, Aged, Chronic Disease, Female, Humans, MMPI/*statistics & numerical data, Male, Middle Aged, Neck Pain/physiopathology/*psychology, Neuropsychological Tests/*statistics & numerical data, Pain Measurement, Physical Examination/methods, Statistics; Nonparametric, Whiplash Injuries/physiopathology/*psychology
Identifiers
urn:nbn:se:umu:diva-14302 (URN)10.1080/13803390490515487 (DOI)15903148 (PubMedID)
Available from: 2007-05-28 Created: 2007-05-28 Last updated: 2009-10-06Bibliographically approved
5. Altered cerebral blood flow in chronic neck pain patients but not in whiplash patients: a 99mTc-HMPAO rCBF study
Open this publication in new window or tab >>Altered cerebral blood flow in chronic neck pain patients but not in whiplash patients: a 99mTc-HMPAO rCBF study
Show others...
2006 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 15, no 8, 1189-1195 p.Article in journal (Refereed) Published
Abstract [en]

A cross-sectional study to investigate regional cerebral blood flow (rCBF) in patients with chronic whiplash syndrome and chronic neck pain patients without previous history of trauma along with a healthy control group. Chronic neck pain is a common disorder and a history of cervical spine injury including whiplash trauma constitute a risk factor for persistent neck pain. The aetiology of the late whiplash syndrome is unknown with no specific diagnostic criteria based on imaging, physiological, or psychological examination. Earlier studies indicate a parieto-occipital hypoperfusion but it is unclear if the hypoperfusion represents a response to chronic pain. The rCBF was monitored in 45 patients with chronic neck pain: 27 cases with chronic whiplash syndrome and 18 age and gender matched cases with non-traumatic chronic neck pain. The rCBF was estimated with single-photon emission computed tomography (SPECT) using technetium-99m hexamethylpropylene amine oxime (HMPAO). The non-traumatic patients displayed rCBF changes in comparison with the whiplash group and the healthy control group. These changes included rCBF decreases in a right temporal region close to hippocampus, and increased rCBF in left insula. The whiplash group displayed no significant differences in rCBF in comparison with the healthy controls. The present study suggests different pain mechanisms in patients with chronic neck pain of non-traumatic origin compared to those with chronic neck pain due to a whiplash trauma.

Keyword
Adult, Chronic Disease, Female, Humans, Male, Middle Aged, Neck Pain/*pathology, Regional Blood Flow, Technetium Tc 99m Exametazime/diagnostic use, Telencephalon/*blood supply, Tomography; Emission-Computed; Single-Photon, Whiplash Injuries/*pathology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-12543 (URN)10.1007/s00586-005-0040-5 (DOI)16614854 (PubMedID)
Available from: 2008-01-11 Created: 2008-01-11 Last updated: 2012-10-10Bibliographically approved

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