The objective of this study is to prove patients with CTTH and chronic neck pain after a whiplash injury have a lower nociceptive flexion reflex threshold compared to painfree controls.
ID
Source
Brief title
Condition
- Headaches
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Primary outcome is the minimum current intensity eliciting a spinal reflex
(reflex threshold).
Secondary outcome
Secondary outcomes are the RIII amplitude, psychological symptoms (SCL-90),
quality of life (SF-36) and the total tenderness score (TTS).
Background summary
The pathophysiology of chronic tension-type headache (CTTH) and of chronic neck
pain after a whiplash trauma is largely unknown. It has been shown that these
patients often show increased pericranial muscle tenderness and muscle hardness.
In two randomized controlled trials we could not prove botulinum toxin (with a
spasmolytic effect) to be effective in patients with CTTH and chronic whiplash
syndrome.
Treatment of these tender muscles did not seem to help the patient. Possible
explanation herefore is the so-called spinal cord hypersensivity.
Patients with CTTH and chronic neck pain after a whiplash trauma show often
exaggerated pain responses following low intensity nociceptive stimulation.
This can explain the persistence of pain after minimal or even in absence of
tissue injury.
The nociceptive flexion reflex (NFR) is a spinal reflex of one limb after
(painful) electrical stimulation of the suralis nerve. It is a reliable and
objective tool to measure pain and the degree of spinal cord hypersensivity.
Patients with chronic pain syndromes seem to have lower reflex thresholds
compared to pain free controls as a result of spinal cord hypersensivity.
Study objective
The objective of this study is to prove patients with CTTH and chronic neck
pain after a whiplash injury have a lower nociceptive flexion reflex threshold
compared to painfree controls.
Study design
After informed consent is obtained, we record baseline demographics (age, sex,
length, weight, bloodpressure). During a baseline period of 4 weeks, patients
use a diary to record the presence of headache and/or neck pain, number of
headache hours per day, number of days on which medication is taken and number
of tablets taken per day. Before and after the NFR measurements patients record
their headache and\or neck pain intensity on a visual rating schaal (VRS), in
which 0 means no pain and 10 the worst pain imaginable.
Study burden and risks
The NFR measurements are non-invasive measurements, according to standard EMG
(electromyograghy) protocols.
Leyweg 275
2545 CH
Nederland
Leyweg 275
2545 CH
Nederland
Listed location countries
Age
Inclusion criteria
Patients are eligible: (1) if they meet the criteria for chronic tension-type headache (according to the International Headache Society criteria = IHS); (2) if they had a whiplash type neck distortion defined as a soft tissue injury of the neck following a vehicle collision, with symptoms lasting longer than 6 months (according to the Quebec task Force, Whiplash Associated Disorders grade 1 and 2)
Exclusion criteria
Age < 18 or > 65 years; pregnancy; neuromuscular disorders; severe psychiatric comorbidity; analgesics abuse
Design
Recruitment
metc-ldd@lumc.nl
Followed up by the following (possibly more current) registration
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Other (possibly less up-to-date) registrations in this register
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In other registers
| Register | ID |
|---|---|
| CCMO | NL11797.098.06 |