Article ID Journal Published Year Pages File Type
2120636 EBioMedicine 2016 9 Pages PDF
Abstract

•Differences of rCBF were explored by PET in cWAD patients and healthy volunteers exposed to four conditions.•Changes in rCBF were observed in cWAD patients in regions involved in pain perception and interoceptive sensory information.•These changes might be the consequence of a mismatch in the integration of interoceptive stimuli in pain processing regions.In the past, published work on chronic whiplash-associated disorders (cWAD) has caused much confusion and discussion, yet functional imaging methods such as positron emission tomography (PET) have demonstrated a variety of different significant alterations in the perfusion or glucose utilization of the brain. The present study, using PET and the perfusion marker, H215O, is a step forward in whiplash research. It shows changes in perfusion in regions directly involved in pain perception and interoceptive sensory information, such as the insular cortex, precuneus, and posterior cingulate, indicating a mismatch in the integration of interoceptive information in pain processing brain regions.

There is increasing evidence of central hyperexcitability in chronic whiplash-associated disorders (cWAD). However, little is known about how an apparently simple cervical spine injury can induce changes in cerebral processes. The present study was designed (1) to validate previous results showing alterations of regional cerebral blood flow (rCBF) in cWAD, (2) to test if central hyperexcitability reflects changes in rCBF upon non-painful stimulation of the neck, and (3) to verify our hypothesis that the missing link in understanding the underlying pathophysiology could be the close interaction between the neck and midbrain structures. For this purpose, alterations of rCBF were explored in a case-control study using H215O positron emission tomography, where each group was exposed to four different conditions, including rest and different levels of non-painful electrical stimulation of the neck. rCBF was found to be elevated in patients with cWAD in the posterior cingulate and precuneus, and decreased in the superior temporal, parahippocampal, and inferior frontal gyri, the thalamus and the insular cortex when compared with rCBF in healthy controls. No differences in rCBF were observed between different levels of electrical stimulation. The alterations in regions directly involved with pain perception and interoceptive processing indicate that cWAD symptoms might be the consequence of a mismatch during the integration of information in brain regions involved in pain processing.

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