THE INFLUENCE OF PATIENTS CHARACTERISTICS ON THE EFFECTIVENESS OF THE CONTEMPORARY NEUROSCIENCE APPROACH IN PATIENTS WITH CHRONIC WHIPLASH ASSOCIATED DISORDERS

J. Bontinck¹, C. Murillo¹, D. Lenoir¹, B. Cagnie¹, M. Meeus¹, K. Ickmans², J. Nijs², I. Coppieters²

¹Ghent University, Department of Rehabilitation Sciences and Physiotherapy, Ghent, Belgium, ²VUB, Department of Rehabilitation Sciences and Physiotherapy, Brussels, Belgium

Background: The contemporary neuroscience approach is an effective treatment for patients with Chronic Whiplash Associated Disorders (CWAD), but not all patients seem to be responders. Unfortunately, clear screening guidelines to obtain patient-tailored treatment are lacking.

Purpose: This study aimed to identify for which patients the neuroscience approach is beneficial, by exploring treatment moderators and predictors.

Methods: A multi-centred double-blinded randomized controlled trial was conducted, in which 120 patients with CWAD were allocated to the experimental (pain neuroscience education and cognition-targeted exercise therapy) or the control intervention (biomedically focused education and exercise therapy). Online questionnaires and Quantitative Sensory Testing measurements were collected at baseline, post-intervention and at 6 months follow up. Linear mixed model analyses were performed to identify moderators and predictors for the primary outcome pain-related disability.

Results: The neuroscience approach was more effective in patients withlower pain thresholds and lower sensory detection thresholds at baseline. The level of catastrophizing or pain-related fear did not influence treatment outcome. Pain intensity and self-reported symptoms of central sensitization were identified as non-specific predictors, showing the higher these scores the smaller response to both treatments.

Conclusions: The neuroscience approach is especially effective in patients with widespread hyperalgesia, but without sensory hypoesthesia. High pain intensity and severe self-reported symptoms of central sensitization seem to characterise poor treatment responders to both treatments. Future research should investigate how to treat this subgroup more effectively.

Implications: The heterogeneous CWAD population shows various treatment responses, which demands patient-tailored strategies. The neuroscience approach is particularly beneficial for a certain subgroup.

Funding acknowledgements: This study was supported by the Research Foundation Flanders (FWO), Belgium [grant number G007217N].

Keywords:
Chronic Whiplash Associated Disorders
Contemporary neuroscience
Central sensitization

Topics:
Disability & rehabilitation
Musculoskeletal: spine
Pain & pain management

Did this work require ethics approval? Yes

Institution: University of Ghent

Committee: Medical Ethics Committees of the University Hospital in Ghent

Ethics number: 2017/0850