A comparison of physical and psychological features of responders and non-responders to cervical facet blocks in chronic whiplash

Ashley Dean Smith, Gwendolen Jull, Geoff Schneider, Bevan Frizzell, Robert Allen Hooper, Michele Sterling, Ashley Dean Smith, Gwendolen Jull, Geoff Schneider, Bevan Frizzell, Robert Allen Hooper, Michele Sterling

Abstract

Background: Cervical facet block (FB) procedures are often used as a diagnostic precursor to radiofrequency neurotomies (RFN) in the management of chronic whiplash associated disorders (WAD). Some individuals will respond to the FB procedures and others will not respond. Such responders and non-responders provided a sample of convenience to question whether there were differences in their physical and psychological features. This information may inform future predictive studies and ultimately the clinical selection of patients for FB procedures.

Methods: This cross-sectional study involved 58 individuals with chronic WAD who responded to cervical FB procedures (WAD_R); 32 who did not respond (WAD_NR) and 30 Healthy Controls (HC)s. Measures included: quantitative sensory tests (pressure; thermal pain thresholds; brachial plexus provocation test); nociceptive flexion reflex (NFR); motor function (cervical range of movement (ROM); activity of the superficial neck flexors during the cranio-cervical flexion test (CCFT). Self-reported measures were gained from the following questionnaires: neuropathic pain (s-LANSS); psychological distress (General Health Questionnaire-28), post-traumatic stress (PDS) and pain catastrophization (PCS). Individuals with chronic whiplash attended the laboratory once the effects of the blocks had abated and symptoms had returned.

Results: Following FB procedures, both WAD groups demonstrated generalized hypersensitivity to all sensory tests, decreased neck ROM and increased superficial muscle activity with the CCFT compared to controls (p < 0.05). There were no significant differences between WAD groups (all p > 0.05). Both WAD groups demonstrated psychological distress (GHQ-28; p < 0.05), moderate post-traumatic stress symptoms and pain catastrophization. The WAD_NR group also demonstrated increased medication intake and elevated PCS scores compared to the WAD_R group (p < 0.05).

Conclusions: Chronic WAD responders and non-responders to FB procedures demonstrate a similar presentation of sensory disturbance, motor dysfunction and psychological distress. Higher levels of pain catastrophization and greater medication intake were the only factors found to differentiate these groups.

Figures

Figure 1
Figure 1
Flow of participants through the study.
Figure 2
Figure 2
Comparison of cervical ROM between groups. ROM = Range of Motion; HC = Healthy Controls; WAD_R = WAD Responders; WAD_NR = WAD Non-Responders; (L) = Left; (R) = Right.
Figure 3
Figure 3
Cranio-cervical flexion test performance across groups. RMS = Root Mean Square; HC = Healthy Controls; WAD_R = WAD Responders; WAD_NR = WAD Non-Responders.

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