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Background and purpose: Physical mechanisms are the possible factors involved in the development and maintenance of long-term handicaps after acute whiplash injury. This study prospectively examined the role of active neck mobility, cervical and extra-cervical pains, as well as non-painful complaints after a whiplash injury as predictors for subsequent handicap. Methods: Consecutive acute whiplash patients ( n = 688) were interviewed and examined by a study nurse after the median of 5 days after injury, and divided into a high- or a low-risk group by an algorithm based on pain intensity, number of non-painful complaints and active neck mobility [active cervical range of motion (CROM)]. All 458 high-risk patients and 230 low-risk patients received mailed questionnaires after 3, 6 and 12 months. Two examiners examined all high-risk patients ( n = 458) and 41 consecutive low-risk patients at median 11, 109, 380 days after injury. The main outcome measures were: handicaps, severe headaches, neck pain and neck disability. Results: The relative risk for a 1-year disability increased by 3.5 with initial intense neck pain and headaches, by 4.6 times with reduced CROM and by four times with multiple non-painful complaints. Conclusion: Reduced active neck mobility, immediate intense neck pain and headaches and the presence of multiple non-painful complaints are the important prognostic factors for a 1-year handicap after acute whiplash. [ABSTRACT FROM AUTHOR]

Unlabelled: OBJECTIVE OF THE INVESTIGATION: In a 6-month prospective study of 141 consecutive acute whiplash-injured participants, and 40 acute, ankle-injured controls, pain and tenderness in the neck/head, and at a distant control site, were measured.Basic Procedures: Muscle palpation and pressure algometry in five head/neck muscle-pairs were performed after 1 week and 1, 3 and 6 months after injury. Algometry was performed at a distant control site.Main Findings: Whiplash-injured patients had lowered pressure-pain-detection thresholds and higher palpation-score initially in the neck/head, but the groups were similar after 6 months, and the control site was not sensitized.Principal Conclusion: Focal, but not generalized, sensitization to musculoskeletal structure is present until 3 months, but not 6 months, after whiplash injury, and probably does not play a major role in the development of late whiplash syndrome. Pressure algometry and palpation are useful clinical tools in the evaluation of neck and jaw pain in acute whiplash injury. [ABSTRACT FROM AUTHOR]

Presents authors' reply to Ferrari's comments on the importance of a suitable control group when examining persons exposed to a whiplash injury.

An abstract of the article "DNIC in whiplash and ankle-injured controls. 1-year prospective findings" by H. Kasch and T. S. Jensen is presented.

STUDY DESIGN.: One-year prospective study of 141 acute whiplash patients (WLP) and 40 acute ankle-injured controls. OBJECTIVE.: This study investigates a priori determined potential risk factors to develop a risk assessment tool, for which the expediency was examined. SUMMARY OF BACKGROUND DATA.: The whiplash-associated disorders (WAD) grading system that emerged from The Quebec Task-Force-on-Whiplash has been of limited value for predicting work-related recovery and for explaining biopsychosocial disability after whiplash and new predictive factors, for example, risk criteria that comprehensively differentiate acute WLP in a biopsychosocial manner are needed. METHODS.: Consecutively, 141 acute WLP and 40 ankle-injured recruited from emergency units were examined after 1 week, 1, 3, 6, and 12 months obtaining neck/head visual analog scale score, number of nonpainful complaints, epidemiological, social, psychological data and neurological examination, active neck mobility, and furthermore muscle tenderness and pain response, and strength and duration of neck muscles. Risk factors derived (reduced cervical range of motion, intense neck pain/headache, multiple nonpain complaints) were applied in a risk assessment score and divided into seven risk strata. RESULTS.: A receiver operating characteristics curve for the Risk Assessment Score and 1-year work disability showed an area of 0.90. Risk strata and number of sick days showed a log-linear relationship. In stratum 1 full recovery was encountered, but for high-risk patients in stratum 6 only 50% and 7 only 20% had returned to work after 1 year (P < 5.4 x 10). Strength measures, psychophysical pain measurements, and psychological and social data (reported elsewhere) showed significant relation to risk strata. CONCLUSION.: The Risk Assessment score is suggested as a valuable tool for grading WLP early after injury. It has reasonable screening power for encountering work disability and reflects the biopsychosocial nature of whiplash injuries. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Randomized, parallel-group trial. OBJECTIVE: To compare the effect of 3 early intervention strategies following whiplash injury. SUMMARY OF BACKGROUND DATA: Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. METHODS: Participants were recruited from emergency units and general practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to 'act-as-usual,' or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12 months postinjury. Treatment effect was measured in terms of headache and neck pain intensity (0-10), disability, and work capability. RESULTS: A total of 458 participants were included. At the 1-year follow-up, 48% of participants reported considerable neck pain, 53% disability, and 14% were still sick listed at 1 year follow-up. No significant differences were observed between the 3 interventions group. CONCLUSION: Immobilization, 'act-as-usual,' and mobilization had similar effects regarding prevention of pain, disability, and work capability 1 year after a whiplash injury. [ABSTRACT FROM AUTHOR]

Our understanding of nociceptive processing and of plastic changes after persistent noxious input has increased immensely within the last two decades. It is now clear that long-lasting noxious stimulation or damage to the nervous system give rise to a neuronal hyperexcitability and that this sensitisation of the nervous system plays an important role for development and maintenance of chronic pain. The manifestations of such hyperexcitability are numerous and include among others: increased neuronal response to a suprathreshold stimulus, expansion of the peripheral areas from where a central neurone can be activated and the recruitment of previous non-responding nociceptive neurones. Furthermore, it has been possible to modulate this neuronal hyperexcitability by the discovery of molecular targets for pain, by sequencing DNA of ion channels and receptors and by development of new molecules that exert their effects on these molecular targets. The changes in responsiveness appear to be partly time and intensity dependent and partly dependent on the cause of injury. Whereas relatively short-lasting and moderate noxious input leads to reversible plastic changes, more intense and long-lasting noxious stimulation implies a risk for persistent and more profound alterations in transmitters, receptors, ion channels and in neuronal connectivity. Despite the explosion of new knowledge in pain processing and in molecular background for neuroplasticity, this progress has unfortunately not resulted in a corresponding improvement of our ability to treat chronic pain. The number of patients with chronic unrelieved pain is still high and newer types of treatment have so far not resulted in a substantially better treatment. Nevertheless, there is now an ongoing systematic research in which chronic pain conditions are assessed in a fashion so that mechanisms underlying pain can be dissected. Moreover, controlled clinical trials together with systematic reviews are carried out... [ABSTRACT FROM AUTHOR]

• MScanFit shows motor unit loss in spinal cord injured patients. • Muscle velocity recovery cycles show muscle membrane depolarization suggesting denervation of paralyzed muscles following spinal cord injury (SCI). • When planning rehabilitation after SCI examination of peripheral nervous system should be considered. To examine the peripheral nervous system (PNS) in spinal cord injured (SCI) patients using two novel methods: (1) MScanFit MUNE; a motor unit number estimation method detecting motor unit loss and (2) muscle velocity recovery cycles (MVRCs) measuring muscle membrane properties which has previously shown depolarization of the muscle membrane in denervated muscles. Thirty chronic SCI patients (lesion above Th10) and twenty-five gender –and age matched healthy controls (HC) were examined. MScanFit was recorded from peroneal nerve to anterior tibial muscle (TA) and tibial nerve to abductor hallucis muscle after excluding localized mononeuropathies. MVRCs were recorded from TA. Nerve conduction studies showed mononeuropathy in 8 patients (27%) (sciatic (2), -or peroneal nerve (6)). SCI patients had in average reduced motor unit number compared with HC and prolonged muscle refractory period and reduced supernormality. A high prevalence of nerve lesion and a diffuse affection of the PNS following SCI are highly relevant findings that should be accounted for when planning neurorehabilitation for persons living with SCI. [ABSTRACT FROM AUTHOR]

• Muscle velocity recovery cycles (MVRCs) show in vivo evidence of depolarized muscle membrane in neurogenic muscles in humans. • MVRC parameters correlate to disease severity and muscle strength but not to disease duration. • MVRC is a useful technique for revealing disease mechanisms in neuromuscular disorders. To examine muscle membrane properties in neurogenic muscles using Muscle Velocity Recovery Cycles (MVRCs). Forty-seven patients referred to Nerve Conduction Studies (NCS) and Electromyography (EMG) for peroneal nerve entrapment neuropathy were prospectively included. The patients were categorized as peroneal nerve entrapment neuropathy across knee (n = 22), L5-radiculapathy (n = 10), normal NCS/EMG (n = 9) and other disorders (n = 6) using NCS/EMG and neuroimaging results. Strength in anterior tibial muscle was measured by Medical Council Scale (MRC) and disease duration was recorded. In addition to conventional NCS/EMG, all subjects were examined with MVRCs in anterior tibial muscle. This provided parameters of muscle relative refractory period (MRRP) and early supernormality (ESN) and late supernormality (LSN). The results were compared with 29 age-matched healthy control subjects. MRRP was prolonged and ESN and LSN were reduced in neurogenic muscles. MRRP, ESN and LSN correlated to MRC and incidence of spontaneous activity but not to motor unit potential parameters or disease duration. MVRC changes provide in vivo evidence of depolarization in intact human muscle fibres that could underlie reduced muscle excitability and hence weakness in neurogenic muscles. MVRCs appear to be a useful technique for revealing disease mechanism in a broad range of neuromuscular diseases. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Nonsystematic review and discussion of prognosis after whiplash injury. OBJECTIVE: To summarize the research and identify a research agenda for improving prognostic models after whiplash injury. SUMMARY OF BACKGROUND DATA: With up to 50% of individuals failing to fully recover after whiplash injury, the capacity to determine a precise estimate of prognosis will be important. Systematic reviews note inconsistencies and shortcomings of research in this area. METHODS: A nonsystematic review and discussion. RESULTS: Most prognostic whiplash studies are phase 1 (exploratory) studies with few confirmatory or validation studies yet available. It is recognized that whiplash is a heterogeneous condition and clinicians require prognostic indicators for clinical use. Although the evidence is not sufficiently strong to make firm recommendations, there are some prognostic factors that have shown consistency across studies and could be considered as preliminary flags or guides to gauge patients potentially at risk of poor recovery. These include pain and/or disability levels, neck range of movement, cold and mechanical hyperalgesia and psychological factors of recovery beliefs/expectations, post-traumatic stress symptoms, depression, and pain catastrophizing. It is not known whether these factors can be modified or whether modification will improve outcomes, thus they should not be considered directives for management. Research priorities identified to develop improved predictive models include confirmation and validation of factors identified in phase 1 studies; investigation of the interaction between variables; investigation of the predictive value of changes in variables over time; the inclusion of validated outcomes including measures of pain and disability as well as perceived recovery and psychological outcomes. CONCLUSION: The current evidence is not sufficiently robust to be able to confidently predict outcome after whiplash injury. A preliminary set of consistent factors has been proposed to assist clinicians in identifying individuals at risk of poor recovery. Directions for the development of improved prognostic models are discussed. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Randomized parallel-group trial with 1-year follow-up. OBJECTIVE: To evaluate whether education of patients communicated orally by a specially trained nurse is superior to giving patients a pamphlet after a whiplash injury. SUMMARY OF BACKGROUND DATA: Long-lasting pain and physical disability after whiplash injuries are related to both serious personal suffering and huge socio-economic costs. Pure educational interventions after such injuries seem generally as effective as more costly interventions, but it is unknown if the way advice is communicated is of any importance. METHODS: Participants with relatively mild complaints after car collisions were recruited from emergency departments and GPs. A total of 182 participants were randomized to either: (1) a 1 hour-educational session with a specially trained nurse, or (2) an educational pamphlet. Outcome parameters were neck pain, headache, disability, and return to work. Recovery was defined as scoring pain 0 or 1 (0-10 point scale) and not being off sick at the time of the follow-ups. RESULTS: After 3, 6, and 12 months 60%, 58%, and 66%, respectively of the participants had recovered. Group differences were nonsignificant on all outcome parameters, even though the outcome tended to be better for the group receiving personal advice. CONCLUSION: Prognosis did not differ between patients who received personal education and those who got a pamphlet. However, a systematic tendency toward better outcome with personal communicated information was observed and the question how patients should be educated to reduce the risk of chronicity after whiplash is worth further investigation, since no treatment have been proven to prevent long-lasting symptoms, and all forms of advice or educational therapy are so cheap that even a modest effect justifies its use. [ABSTRACT FROM AUTHOR]

Based on a high affinity to the enzyme estrone sulfatase (ES), 16α-[18F]fluoroestradiol-3,17β-disulfamate ([18F]FESDS) has been suggested as a potential PET radiotracer for imaging steroid-dependent breast tumours. The distribution of [18F]FESDS was studied in rats, tumour-bearing nude mice and piglets. In all species evidence for binding to a second target, the enzyme carbonic anhydrase (CA), was obtained. ES and CA inhibitors significantly reduced the radiotracer uptake in various organs but not in tumours. It is concluded that [18F]FESDS binds to ES and CA in vivo but this binding is not strong enough to allow tumour imaging with positron emission tomography (PET). [Copyright &y& Elsevier]

16α-Fluoroestradiol-3,17β-disulfamate (FESDS) strongly inhibits estrone sulfatase (ES), an enzyme which is also present in the brain. The enzyme is probably involved in important regulatory functions of neurosteroids which may be disturbed in certain brain diseases. In the present study, [18F]FESDS was used to measure the amount of ES in various rat brain regions using quantitative in vitro autoradiography. The obtained values vary between 0.29 pmol (mg protein)–1 (pons) and 11.5 pmol (mg protein)–1 (striatum). They are positively correlated with the enzyme activity measured in homogenates of the corresponding regions. Because this radiotracer binds also to carbonic anhydrase in the brain it is only of limited use for in vivo imaging studies. [Copyright &y& Elsevier]