In recent times, there has been increased interest on the identification of nociceptive processes that may underlie various musculoskeletal conditions including neck pain and whiplash-associated disorder (WAD). The latter condition is recalcitrant to conservative treatment approaches and it has been logically reasoned that improved understanding of the processes underlying this and similar conditions may pave the way for the development and testing of improved management strategies. Recent data indicate that augmented central pain processing mechanisms (central hyperexcitability) is a likely feature of various musculoskeletal conditions, including WAD, cervical radiculopathy, and arthritis. More importantly, sensory responses indicative of augmented pain processing have demonstrated predictive capacity to identify those likely to have poor functional recovery following whiplash injury, resulting in recommendations that such measures be included in the assessment of people with acute WAD.

J Orthop Sports Phys Ther 2011;41(9):623-624. doi:10.2519/jospt.2011.0106

KEY WORDS: nociceptive process, WAD, whiplash-associated disorder

Neck pain is a common health problem that affects approximately 70% of individuals at some time in their lives. International epidemiological data suggest that a point prevalence of between 10% and 40% of the population will experience neck in any 1 year. It is often considered that the course of neck pain is favorable, with the majority of people showing full recovery; however, recent data suggest that this may not be the case. The course of neck pain is marked by periods of recurrence and exacerbation, with most people not reporting full symptom resolution following a whiplash injury. These data provide a challenge to all clinicians and researchers involved in the management of cervical spine pain to develop improved preventative and management approaches. A first step in this process would be to gain a deeper understanding of the processes underlying various neck pain conditions.

J Orthop Sports Phys Ther 2009;39(5):309-311. doi:10.2519/jospt.2009.0113

KEY WORDS: cervical spine, neck pain

SYNOPSIS: The development of chronic pain and disability following whiplash injury is common and contributes substantially to personal and economic costs related with this condition. Emerging evidence demonstrates the clinical presence of alterations in the sensory and motor systems, including psychological distress in all individuals with a whiplash injury, regardless of recovery. However, individuals who transition to the chronic state present with a more complex clinical picture characterized by the presence of widespread sensory hypersensitivity, as well as significant posttraumatic stress reactions. Based on the diversity of the signs and symptoms experienced by individuals with a whiplash condition, clinicians must take into account the more readily observable/measurable differences in motor, sensory, and psychological dysfunction. The implications for the assessment and management of this condition are discussed. Further review into the pathomechanical, pathoanatomical, and pathophysiological features of the condition also will be discussed. LEVEL OF EVIDENCE: Level 5.

J Orthop Sports Phys Ther 2009;39(5):312-323, Epub 3 June 2008. doi:10.2519/jospt.2009.2826

KEY WORDS: cervical spine, neck, WAD