טכניון מכון טכנולוגי לישראל
הטכניון מכון טכנולוגי לישראל - בית הספר ללימודי מוסמכים  
Ph.D Thesis
Ph.D StudentKuperman Tzipora Miriam
SubjectResearch to Determine Acute Pain Impact on the Development
of Chronic Pain: a Study of mTBI Post-Motor
Vehicle Collision
DepartmentDepartment of Medicine
Supervisors Professor David Yarnitsky
Dr. Michal Granot
Full Thesis textFull thesis text - English Version


Abstract

Chronic pain is a common consequence of motor vehicle collision (MVC). Although studies have attempted to define predictive parameters for pain chronification no consistent factors have emerged; due in part to the variability created by the sensory-discriminative and affective-motivation components of the pain experience. Variability which may contribute to seemingly ‘minor’ injuries resulting in major long-term pain and disability. The classic approach delegated post-collision individuals based on either whiplash or mild traumatic brain injury (mTBI). Although some reports suggest that similar post-traumatic symptom patterns follow both.

171 participants were recruited and assessed (psychological, clinical, psychophysical) in the very-early acute phase (≤72 hr) of this prospective non-interventional study, and followed for one-year (age range 19-67, 68F). Of which 153 were defined as having an mTBI post-MVC with complaints of neck pain, and could be included in the analysis. 

We explored the somatic and affective processes inherent in the very-early acute and chronic pain phases, as well as contributing factors for the transition from acute to chronic pain. We found: 1) the extent of pain in the head and neck and number of affected body areas signs were correlated to sensory hypersensitivity at the very-early acute stage, but not to changes in individual’s psychological profile; 2) variability in very-early acute pain reports can be better explained by the addition of a psycho-cognitive tool, the Pain Sensitivity Questionnaire, as an expansion of the psychophysically-based PMP and should inform treatment decisions as they are predictive of pain presentation at one-year; and 3) while the pain trajectory and level of reported pain over the year is the same for head and neck, the components of head and neck-related disability are shaped by different factors, with neck-related disability comprised solely of physical components, and mTBI-related disability of both physical and psychological factors.

In conclusion post-collision patients usually have signs of head and neck pain and seem to behave both like classic post-mTBI and classic post-whiplash patients in their pain presentation in the acute and chronic phases as well as in pain trajectory, this bridges the gap between the two definitions and challenges the two separate disorders status quo conceptualization. Additionally, while the somatic factors seem to exert influence at every stage, affective pain components were found to influence pain in the form of disability only at the chronic stage.