Modulation of Cervical Facet Joint Nociception and Pain Attenuates Physical and Psychological Features of Chronic Whiplash

The purpose of this study was to investigate changes in clinical (physical and psychological) features of individuals with chronic whiplash-associated disorder who had previously undergone cervical radiofrequency neurotomy at the time point when the effects of radiofrequency neurotomy had dissipated and pain returned. Individuals underwent radiofrequency neurotomy and were assessed prior to radiofrequency neurotomy; at 1 and 3 months after the procedure, and then after the return of pain (approximately 10 months postprocedure). Quantitative sensory tests (pressure; thermal pain thresholds; brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement; craniocervical flexion test) were measured. Self-reported disability, psychological distress, pain catastrophization, and posttraumatic stress disorder symptoms were measured as well. Upon the return of pain after radiofrequency neurotomy, levels of disability increased (P < .0001), and were no different to those before radiofrequency neurotomy (P = .99). There was also a significant deterioration in quantitative sensory testing measures and reduced cervical range of motion after the return of pain (all P .22). There were no significant changes in pressure hyperalgesia (P > .054) or craniocervical flexion test performance (P > .07), after the return of pain. Psychological distress and pain catastrophizing increased significantly after the return of pain (P .13). Although, there was no difference in number or severity of posttraumatic stress symptoms after the return of pain (P > .30).

Physical and psychological features of chronic whiplash-associated disorder are modulated dynamically with cervical radiofrequency neurotomy. These findings suggest that peripheral nociception is involved in the presentations of chronic whiplash-associated disorder in this cohort of individuals.