Neurobiological Mechanisms Underlying Chronic Whiplash Associated Pain: The Peripheral Maintenance of Central Sensitization

Abstract

Objective: To review the current neurophysiologic basis for the chronic pain experience, as it may apply to chronic whiplash.Findings: There appears to be a dichotomy in our understanding of the chronic pain experience, and its cause. On the one hand, a simple physical tissue trauma that has failed to heal, does not explain what is currently observed as chronic pain behavior. Psychological problems and/or secondary gain are associated factors, suggesting the lack of a physical disorder. Recent findings on the neural mechanisms of pain, indicate that there may be some individuals whose traumatic event may have sensitized certain neurophysiologic processes to interpret as pain, from experiences of otherwise ordinary sensory-perception events. These central sensitization events could be caused or aggravated by various combinations of trauma, psychological disorders, or secondary gain and may provide at least a partial explanation of why some persons may develop chronic pain, and others will not.