A neuropathic pain component is common in acute whiplash and associated with a more complex clinical presentation

Abstract

Whiplash is a heterogeneous condition with some individuals showing features suggestive of neuropathic pain. This study investigated the presence of a neuropathic pain component in acute whiplash using the Self-reported Leeds Assessment of Neuropathic Signs and Symptoms' scale (S-LANSS) and evaluated relationships among S-LANSS responses, pain/disability, sensory characteristics (mechanical, thermal pain thresholds, and Brachial plexus provocation test (BPPT) responses) and psychological distress (General Health Questionnaire-28 (GHQ-28)). Participants were 85 people with acute whiplash (<4 weeks) (54 females, age 36.27 ± 12.69 years). Thirty-four percent demonstrated a predominantly neuropathic pain component (S-LANSS ≥ 12). This group showed higher pain/disability, cold hyperalgesia, cervical mechanical hyperalgesia, and less elbow extension with the BPPT ( p < 0.03) when compared to the group with non-neuropathic pain (S-LANSS ≤ 12). Pressure pain thresholds (PPTs) at distant sites and psychological distress (GHQ-28) were not different between the groups ( p > 0.09). None of the S-LANSS items could discriminate those with cold hyperalgesia ( p = 0.06). A predominantly neuropathic pain component is related to a complex presentation of higher pain/disability and sensory hypersensitivity. The S-LANSS may be a useful tool and the BPPT a useful clinical test in the early assessment of whiplash.