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Hintergrund: Das Schleudertrauma zählt zu den häufigsten Verletzungen nach einem entschädigungspflichtigen Verkehrsunfall. Aufgrund von Schadenersatzanforderungen oder rechtlichen Fragen ist dieses Krankheitsbild auch von sozialmedizinischer Bedeutung. Durch die Vielfalt der Symptome sind die Betroffenen häufig in ihren alltäglichen Aktivitäten stark eingeschränkt. Bei der Behandlung eines Schleudertraumas wird eine konservative Therapie empfohlen, hierbei nimmt die Physiotherapie eine essentielle Rolle ein. Durch unterschiedlichste Faktoren kann es zu einer Chronifizierung der Symptome kommen. Die Chronifizierung schränkt die Betroffenen in ihrem Alltag sowie in ihrer Lebensqualität stark ein. Fragestellung: Somit stellt sich die Frage, welche physiotherapeutischen Behandlungsmethoden bei einem Schleudertrauma im chronischen Stadium verfügbar sind und wie effektiv diese in Bezug auf die Linderung der Beschwerden sind. Ergebnisse: Nackenspezifisches Training ist sowohl mit als auch ohne zusätzlichem kognitiven Verhaltens-/Edukationsansatz der allgemeinen körperlichen Aktivität überlegen. Die Progression der Übungen wurde individuell auf die Betroffenen abgestimmt. Es kam zu einer Reduktion der Schmerzen, zu einer Verbesserung der mentalen und körperlichen Funktion, sowie zu einer verringerten Einschränkung der Betroffenen. Es zeigte sich auch eine Verbesserung der subjektiven Schwindelintensität und der dynamischen Balance. Beim Einsatz des nackenspezifischen Trainings mit oder ohne kognitiven Verhaltens-/Edukationsansatz beim Schleudertrauma Grad 3, kam es darüber hinaus auch zu einer Kraftsteigerung der Kennmuskulatur der oberen Extremität, obwohl sich die Kräftigungsübungen isoliert auf die Nackenmuskulatur konzentrierten. Eine deutliche Verstärkung der Effekte des nackenspezifischen Trainings aufgrund der zusätzlichen kognitiven Komponente konnte nicht nachgewiesen werden. Weswegen aufgrund der Kosteneffektivität vorab immer abgewogen werden sollte, ob ein zusätzlicher kognitiver Verhaltens-/Edukationsansatz unbedingt notwendig ist. Darüber hinaus wurde festgestellt, dass neben der Art der Interventionen auch die biopsychosozialen Faktoren bei der Behandlung eine entscheidende Relevanz haben. Weiters zeigten „Dry-needling“ und „Sham Dry-needling“ zwar positive Effekte, die Ergebnisse waren jedoch nicht klinisch relevant. Conclusio: Aktive Physiotherapie, inklusive funktioneller Stabilität und Mobilität der Halswirbelsäule, zeigt positive Effekte in vielen Studien. Nackenspezifisches Training steht im Mittelpunkt der Therapie. Ob eine zusätzliche kognitive Komponente notwendig ist, sollte individuell auf die Patientinnen und Patienten und in Hinblick auf die Kosteneffektivität abgestimmt werden. Eine frühzeitige Identifikation der Risikofaktoren einer Chronifizierung ist ebenfalls von besonderer Bedeutung für die Behandlung. Background: Whiplash is one of the most common injuries after a compensable traffic accident. Due to claims for compensation or legal issues, this clinical picture is also of socio-medical importance. Due to the variety of symptoms, the patients are often severely restricted in their activities of daily living. In the treatment of whiplash, conservative therapy is recommended, with physiotherapy playing an essential role. A wide variety of factors can cause the symptoms to become chronic. Chronification severely restricts the patients in their everyday life and in their quality of life. Objectives: This raises the question of which physiotherapeutic treatment methods are available for whiplash in the chronic stage and how effective they are in alleviating the symptoms. Results: Neck-specific exercise is superior to general physical activity both with and without an additional cognitive behavioral/educational approach. The progression of exercises was individualized to the patients, leading to a reduction in pain, improvement in mental and physical function, and reduced limitation of the affected individuals. Additionally, subjective dizziness intensity was reduced and dynamic balance improved. When neck-specific training was applied with or without a cognitive behavioral/educational approach in grade 3 whiplash, there was also an increase in strength of the upper extremity characteristic muscles, even though the strengthening exercises purely focused on the neck muscles. Applying additionally cognitive therapy did not significantly enhance the effects of the neck-specific training. Therefore, applying an additional cognitive behavioral/educational approach always requires thorough consideration beforehand, keeping the additional costs in mind. Another result yielded by reviewing the literature, was that biopsychosocial factors are also of crucial relevance in treatment. Furthermore, dry-needling and sham dry-needling showed positive effects, but the results were not clinically relevant. Conclusion: Active physiotherapy, including functional stability and mobility of the cervical spine, yielded positive effects in many studies. Neck-specific training is the focus of therapy. Whether an additional cognitive component is necessary should be individually tailored to the patient and considered in terms of cost-effectiveness. Early identification of risk factors for chronification is also of particular importance for treatment. verfasst von: Selina Marie Degold Abweichender Titel laut Übersetzung der Verfasserin/des Verfassers Bachelorarbeit FH JOANNEUM 2022

Chronic spinal pain, including both neck and low back pain, is a common disabling disorder in which sleep problems are frequently reported as a comorbidity. The complex processes of both sleep and chronic pain seem to have overlapping mechanisms, which may explain their often established bidirectional relationship. This systematic review aims to investigate the assumed association between sleep and chronic spinal pain by providing an overview of the literature from the last decade. Eligible studies were obtained by searching four databases (PubMed, Embase, Web of Science, and PsycARTICLES). Articles were found relevant if they included a human adult population and investigated the possible association between sleep parameters and chronic spinal pain. Only studies published after January 2009 were included, as this review aimed to provide an update of a previous literature overview on this topic. The quality of the studies was assessed by risk of bias and level of evidence. A total of twenty-seven studies (6 cohort, 5 case-control, and 16 cross-sectional studies) were included in this systematic review. The methodological quality of these studies was low to moderate. The majority of studies reported weak to moderate evidence for an association between sleep parameters and chronic spinal pain, with more severe pain accompanied by more disturbed sleep. Addressing frequently reported sleep problems in chronic spinal pain patients therefore appears to be a necessary complement to pain management to achieve optimal treatment outcomes., SCOPUS: re.j, info:eu-repo/semantics/published

BACKGROUND: Patients with chronic fatigue syndrome (CFS) and chronic whiplash associated disorders (cWAD) present a reduced ability to activate central descending nociceptive inhibition after exercise, compared to measurements before exercise. It was hypothesised that a dysfunctional motor-induced inhibition of nociception partly explains this dysfunctional exercise-induced hypoalgesia. This study investigates if engagement of the motor system during movement preparation inhibits nociception-evoked brain responses in these patients as compared to healthy controls (HC). METHODS: The experiment used laser-evoked potentials (LEPs) during three conditions (no task, mental task, movement preparation) while recording brain activity with a 32-channel electroencephalogram in 21 patients with cWAD, 20 patients with CFS and 18 HC. Two-factor mixed design Analysis of variance were used to evaluate differences in LEP amplitudes and latencies. RESULTS: No differences in N1, N2, N2P2, and P2 LEP amplitudes were found between the HC, CFS, and cWAD groups. After nociceptive stimulation, N1, N2 (only at hand location), N2P2, and P2 LEP amplitudes significantly decreased during movement preparation compared to no task (within group differences). CONCLUSION: Movement preparation induces a similar attenuation of LEPs in patients with CFS, patients with cWAD and HC. These findings do not support reduced motor-induced nociceptive inhibition in these patients. ispartof: JOURNAL OF CLINICAL MEDICINE vol:9 issue:5 ispartof: location:Switzerland status: published

Highlights • Treating the central nervous system and psychosocial factors in chronic spinal pain. • This protocol combines pain neuroscience education and cognition targeted exercises. • This paper can be used as guidelines for implementation in clinical practice., Background Nonspecific chronic spinal pain is a common problem within the chronic pain population and is characterized by high social, economic and personal impact. To date, therapists are still struggling in adequately treating these types of patients, as seen in the small and short-term benefits of frequently applied primary care treatments. It is remarkable that despite the well-documented presence of abnormalities in central nociceptive processing in nonspecific chronic spinal pain patients, the implementation of this knowledge in clinical practice is still nearly non-existent. Methods This paper provides the treatment protocol used in a large randomized controlled trial that aimed to assess the effectiveness of a modern neuroscience approach compared to usual care evidence-based physiotherapy. This comprehensive pain neuroscience treatment program combines pain neuroscience education and cognition-targeted exercise therapy. Conclusion Based on previous small-scaled studies, this treatment protocol is expected to normalize central alterations by addressing central nervous system dysfunctions, psychological factors, as well as peripheral dysfunctions in a broader biopsychosocially-driven framework.

Background: The awareness is growing that central sensitization is of prime importance for the assessment and management of chronic pain, but its classification is challenging clinically since no gold standard method of assessment exists. Objectives: Designing the first set of classification criteria for the classification of central sensitization pain. Methods: A body of evidence from original research papers was used by 18 pain experts from 7 different countries to design the first classification criteria for central sensitization pain. Results: It is proposed that the classification of central sensitization pain entails 2 major steps: the exclusion of neuropathic pain and the differential classification of nociceptive versus central sensitization pain. For the former, the International Association for the Study of Pain diagnostic criteria are available for diagnosing or excluding neuropathic pain. For the latter, clinicians are advised to screen their patients for 3 major classification criteria, and use them to complete the classification algorithm for each individual patient with chronic pain. The first and obligatory criterion entails disproportionate pain, implying that the severity of pain and related reported or perceived disability are disproportionate to the nature and extent of injury or pathology (i.e., tissue damage or structural impairments). The 2 remaining criteria are 1) the presence of diffuse pain distribution, allodynia, and hyperalgesia; and 2) hypersensitivity of senses unrelated to the musculoskeletal system (defined as a score of at least 40 on the Central Sensitization Inventory). Limitations: Although based on direct and indirect research findings, the classification algorithm requires experimental testing in future studies. Conclusion: Clinicians can use the proposed classification algorithm for differentiating neuropathic, nociceptive, and central sensitization pain. Key words: Chronic pain, diagnosis, hypersensitivity, classification, neuropathic pain

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Chronic whiplash is a debilitating condition characterized by increased sensitivity to painful stimuli, maladaptive illness beliefs, inappropriate attitudes, and movement dysfunctions. Previous work in people with chronic low back pain and chronic fatigue syndrome indicates that pain neurophysiology education is able to improve illness beliefs and attitudes as well as movement performance. This single-case study (A-B-C design) with six patients with chronic whiplash associated disorders (WAD) was aimed at examining whether education about the neurophysiology of pain is accompanied by changes in symptoms, daily functioning, pain beliefs, and behavior. Periods A and C represented assessment periods, while period B consisted of the intervention (pain neurophysiology education). Results showed a significant decrease in kinesiophobia (Tampa Scale for Kinesiophobia), the passive coping strategy of resting (Pain Coping Inventory), self-rated disability (Neck Disability Index), and photophobia (WAD Symptom List). At the same time, significantly increased pain pressure thresholds and improved pain-free movement performance (visual analog scale on Neck Extension Test and Brachial Plexus Provocation Test) were established. Although the current results need to be verified in a randomized, controlled trial, they suggest that education about the physiology of pain is able to increase pain thresholds and improve pain behavior and pain-free movement performance in patients with chronic WAD.

Background Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study. Methods Data from the Norwegian population-based “Hordaland Health Study” (HUSK, 1997–99); N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45). Results Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p Conclusions The increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model for chronic whiplash, challenges the standard injury model for whiplash, and is indicative evidence of chronic whiplash being a functional somatic syndrome.

BACKGROUND Pain can be influenced by several factors, including stress. Stress can have various reactions on pain. These reactions are influenced by several internal factors such as gender, age, and experience with stress or pain. OBJECTIVES To determine the effect of acute stress on mechanical hyperalgesia (with pressure pain thresholds [PPT]), endogenous pain facilitation (measured by temporal summation [TS]), and inhibition (measured by conditioned pain modulation [CPM]) in healthy people and to determine which factors are responsible for this stress result. STUDY DESIGN Pre-posttest design. SETTING Healthy volunteers from Belgium. METHODS One hundred and one healthy pain-free patients underwent a modified Trier Social Stress Test. Prior and following the stress manipulation, PPT, TS, and CPM efficacy were determined in the mm. trapezius and quadriceps and overall. Furthermore, possible explanatory factors, such as fear of pain, pain catastrophizing, pain hypervigilance, and daily activity levels, were assessed using questionnaires. RESULTS We found a significant stress result on widespread pain sensitivity, with an increase of PPT (P < 0.001), unchanged TS (P > 0.05), and a decrease in CPM efficacy (P < 0.001). Factors associated with the stress result were age, previous surgery, attentional focus on the conditioning stimulus during CPM, fear of pain, and daily activity levels. LIMITATIONS The efficacy of the stress manipulation was not examined, and the lack of a control group prevented to examine a real stress-effect. Furthermore, no physiologic parameters were measured as possibly influencing internal factors for the stress-result. CONCLUSIONS The increase in PPT was not a clinically significant change, whereas the decrease in CPM was meaningful. None of the factors predicted the stress result in all experimental pain measurements, and the predictions that were observed only explained a small proportion of the observed effects.

Background: Chronic neck pain is a common problem with a poorly understood pathophysiology. Often no underlying structural pathology can be found and radiological imaging findings are more related to age than to a patient's symptoms. Besides its common occurrence, chronic idiopathic neck pain is also very disabling with almost 50% of all neck pain patients showing moderate disability at long-term follow-up. Central sensitization (CS) is defined as "an amplification of neural signaling within the central nervous system that elicits pain hypersensitivity," "increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input," or "an augmentation of responsiveness of central neurons to input from unimodal and polymodal receptors." There is increasing evidence for involvement of CS in many chronic pain conditions. Within the area of chronic idiopathic neck pain, there is consistent evidence for the presence and clinical importance of CS in patients with traumatic neck pain, or whiplash-associated disorders. However, the majority of chronic idiopathic neck pain patients are unrelated to a traumatic injury, and hence are termed chronic idiopathic non-traumatic neck pain. When comparing whiplash with idiopathic non-traumatic neck pain, indications for different underlying mechanisms are found. Objective: The goal of this article was to review the existing scientific literature on the role of CS in patients with chronic idiopathic non-traumatic neck pain. Study Design: Systematic review. Setting: All selected studies were case control studies. Methods: A systematic search of existing, relevant literature was performed via the electronic databases Medline, Embase, Web of Science, Cinahl, PubMed, and Google Scholar. All titles and abstracts were checked to identify relevant articles. An article was considered eligible if it met following inclusion criteria: (1) participants had to be human adults (> 18 years) diagnosed with idiopathic non-traumatic chronic (present for at least 3 months) neck pain; (2) papers had to report outcomes related to CS; and (3) articles had to be full-text reports or original research (no abstracts, case-reports, reviews, meta-analysis, letters, or editorials). Results: Six articles were found eligible after screening the title, abstract and - when necessary the full text for in- and exclusion criteria. All selected studies were case-control studies. Overall, results regarding the presence of CS were divergent. While the majority of patients with chronic traumatic neck pain (i.e. whiplash) are characterized by CS, this is not the case for patients with chronic idiopathic neck pain. The available evidence suggests that CS is not a major feature of chronic idiopathic neck pain. Individual cases might have CS pain, but further work should reveal how they can be characterized. Limitations: Very few studies available. Conclusions: Literature about CS in patients with chronic idiopathic non-traumatic neck pain is rare and results from the available studies provide an inconclusive message. CS is not a characteristic feature of chronic idiopathic and non-traumatic neck pain, but can be present in some individuals of the population. In the future a subgroup with CS might be defined, but based on current knowledge it is not possible to characterize this subgroup. Such information is important in order to provide targeted treatment.