Is Traumatic And Non Traumatic Neck Pain Doc Anet Be-Books Pdf

Is Traumatic and Non Traumatic Neck Pain doc anet be
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Pain Physician May June 2017 20 245 260,C hronic neck pain affects many people who. have encountered an episode of neck pain,throughout their lifetime with 50 85 of. people who experienced neck pain reporting neck pain. 1 5 years later 1 2, of activity that the brain generates at a certain loca. tion is often measured via its blood perfusion and or. metabolism Single photon emission computed tomog,raphy SPECT and photon emission tomography PET. are both applied for this purpose 36 Both methods, Two groups of non specific neck pain patients have use radiopharmaceutical tracers to assess the brain s.
been identified in the literature i e patients who have perfusion and or metabolism Active brain regions have. developed neck pain after a traumatic event which a higher need of oxygen and glucose which is reflected. are referred to as patients with whiplash associated in a higher perfusion and or metabolism 37 38 These. disorders WAD 3 and patients with non traumatic changes in metabolite concentration are captured and. idiopathic neck pain INP Whiplash injuries usually reflected in the image signal intensity Another method. result from rear end motor vehicle collisions resulting to analyze brain function is by applying functional. in acceleration deceleration mechanisms of forces act magnetic resonance imaging MRI The MRI method. ing on the neck and the head 4 The traumatic neck most often used to provide information related to brain. pain group is frequently seen as a special case as these function is called blood oxygenation level dependent. patients more often develop chronic complaints 5 6 BOLD contrast imaging 39 This method is based on. which do not only consist of neck pain and or head MRI made sensitive to changes in oxygen consumption. aches but also include other symptoms such as dizziness with an increase in consumption reflecting higher sig. 7 motor dysfunction 8 13 disturbed central pain nal intensities in these BOLD images. processing or central sensitization 14 15 and cogni Besides brain function brain morphology is also. tive impairment 5 16 19 hence the term associated believed to be altered in certain pain conditions 40 41. disorders In addition patients with INP have devel MRI has achieved the level of gold standard for mea. oped neck pain without any clear underlying cause 20 suring brain morphology typically through voxel or. These patients are mostly not characterized by central surface based methods 42 Both methods provide. sensitization 21 cognitive impairment and dizziness information on white and grey matter volume. however they also display motor dysfunctions 22 23 According to our knowledge no systematic review. and chronic or recurrent pain has critically summarized the current evidence regard. The cause of this diversity in symptoms observed in ing brain alterations in patients with WAD and patients. patients suffering from acute and chronic pain is still with INP This systematic review determines the present. not entirely clear Some have suggested that alteration state of the art and steers further research in patients. of the central nervous system could explain this diver with WAD and INP The aim of this systematic review. sity 22 24 27 and a theoretical framework for central is to review and critically appraise the current existing. nervous system alterations such as brain alterations evidence related to structural and functional brain. has already been constructed for acute and chronic pain alterations in patients with WAD and INP In addition. 28 29 Surprisingly only a few have tried to analyze this review evaluates the association between these. and publish results that might support these theories brain alterations and the different clinical symptoms. In addition it is known that a trauma can result in mild reported in patients with neck pain. traumatic brain injury MTBI 30 which is associated. with clinical symptoms similar to these observed in pa. tients with WAD However information on the impact, of a whiplash trauma on the brain remains scarce in Protocol. patients with neck pain To answer the question if brain This systematic review applies the guidelines issued. alterations play a role in patients suffering from chronic in the PRISMA statement an adaptation of the QUORUM. pain the application of new brain analysis tools is ris statement for reporting systematic reviews 43 44. ing 31 36 However only limited research is available. on alterations in brain morphology and function in Information Sources. patients with WAD and INP The electronic databases PubMed http www. Brain alterations are often categorized into func ncbi nlm nih gov pubmed Cochrane Library www. tional alterations and morphological or structural cochranelibrary com and Web of Science www. alterations Brain function which reflects the amount webofscience com were searched to identify relevant. 246 www painphysicianjournal com, Is Traumatic and Non traumatic Neck Pain Associated with Brain Alterations. articles Additionally to make the search as complete Data Collection Process and Items. as possible reference lists of the eligible papers were Data were extracted from eligible papers in a. screened Databases were searched on December 4 standardized manner by RDP and the extracted data. 2015 and all articles were screened afterwards on eli were checked afterwards by a second reviewer IC who. gibility criteria made changes where necessary Disagreements were. resolved by consensus or the opinion of a third review. Literature Search Strategy er MM Extracted data consisted of author and year. The search strategy was based on a combination of of publication description of the included population. Mesh terms only for searching PubMed and free text and if available the controls sample size neck pain. words derived from the following PICO format partici type mean age gender duration of complaints before. pants P had to suffer from acute subacute or chronic scanning the imaging protocol SPECT PET or MRI. INP neck injuries or WAD the measurement instrument with technical information on the scanning sequence. I had to include medical brain imaging techniques such or radiopharmaceutical tracers used in the scanning. as MRI PET and SPECT and the outcome O had to refer procedure the brain tissue class and areas that were. to brain alterations including brain function and brain investigated during the scanning sequence and the. morphology The complete entered search strategy in main findings and associations with clinical measures. PubMed was neck pain OR Neck Pain Mesh OR Spearman correlations rs Pearson correlations rp. whiplash OR Whiplash Injuries Mesh OR neck inju, ry OR Neck Injuries Mesh AND brain imaging OR Risk of Bias in Individual Studies. Neuroimaging Mesh OR fMRI OR rs fMRI OR MRI To assess the methodological quality of all eligible. OR Magnetic Resonance Imaging Mesh OR Magnetic papers 2 independent reviewers RDP and IC both. Resonance Imaging OR Positron Emission Topography PhD candidates experienced in conducting systematic. OR PET OR Positron Emission Tomography Mesh reviews screened all articles on risk of bias using a modi. OR CT OR Computed Tomography OR SPECT OR fied version of The Newcastle Ottawa Scale NOS for as. Tomography X Ray Computed Mesh AND brain sessing the quality of non randomized studies in meta. morphology OR Brain Mesh OR brain OR white analyses www ohri ca programs clinical epidemiology. matter OR grey matter OR gray matter OR White oxford asp 45 This checklist is recommended for case. Matter Mesh OR Gray Matter Mesh OR brain func control and cohort studies 46 and has been proposed. tion OR resting state OR BOLD OR brain volume by the Cochrane Collaboration www cochrane org. Two different checklists were used to assess the quality. Eligibility Criteria of cross sectional case control and cohort studies The. Only patient controlled cross sectional and cohort case control checklist evaluates selection of the popu. studies reporting on brain alterations in non specific lation case definition representativeness of cases and. non traumatic and traumatic acute subacute or chronic selection of controls and comparability controlled for. neck pain patients were eligible for inclusion in this the most important confounders such as age gender. systematic review No restrictions on publication date or education level and BMI The cohort checklist evalu. status were imposed Studies had to be written in Eng ates selection representativeness of the cohort selec. lish Dutch or French to be included in this systematic tion controls case definition new cases comparability. review Adult participants 18 or older suffering from id controlled for the most important confounders age. iopathic neck pain or a whiplash injury were considered gender education level BMI and exposure follow. eligible Assessment of brain alterations should focus on up In addition for both checklists 4 scoring items. brain structure morphology and or brain function and specifically developed for the content of this system. only imaging techniques such as SPECT PET and MRI atic review were added description of MRI protocol. were included in this systematic literature review quality control of images blindness of researcher same. method applied for cases and controls Further details. Study Selection on the different criteria are displayed in Table 1 Each. Two reviewers BC and RDP independently cross sectional study could reach a maximum score of. screened all articles on eligibility in a standardized 9 and each cohort study could reach a maximum score. manner Disagreement between the reviewers was of 11 on the modified NOS representing the highest. resolved by consensus methodological quality,www painphysicianjournal com 247. Pain Physician May June 2017 20 245 260, Table 1 Methodological quality of included studies.
Cross sectional Study Design,Case Case Selection Quality Same Total 9. Comparability4 MRI5a Blindness5c, Definition1 Description2 Controls3 Control5b Method6. Borchgrevink et al,Sundstr m et al,Linnman et al,Sturzenegger et al. Radanov et al,Otte et al,Lorberboym et al,Linnman et al. Freitag et al,Bakhtadze et al,score fulfilled score not fulfilled.
Modified Newcastle Ottawa Quality Assessment Scale cross sectional studies 1 Is the case definition adequate Independent validation or. self reported 2 Representativeness of cases Random sample description of area hospital and clinic 3 Selection of controls Community. controls with no history of disease Hospital controls with no history of disease 4 Comparability Controlled for the most important. confounders age gender cognition BMI 5a Description of MRI protocol full description and optimal sequencing protocol 5b Quality. control of images fully described 5c Blindness researchers were blinded for patient s status 5d Same method used for controls cases yes. Cohort Study Design, Exposed Selection Ascertainment New Quality Same Follow. Parity5 MRI6a Blindness6c 11, Cohort1 Controls2 of Exposure3 Cases4 Control6b Method7 up8. et al 1998 3 27,score fulfilled score not fulfilled. 1 Representativeness of exposed cohort truly representative average in the community 2 Selection controls Drawn from the same commu. nity 3 Ascertainment of exposure Independent validation or self reported 4 New cases Yes 5 Comparability Controlled for the most. important confounders age sex cognition BMI 6a Description of MRI protocol Full description and optimal sequencing protocol 6b. Quality control of images fully described 6c Blindness researcher was blinded for patient s status 7 Same method used for controls cases. yes 8 Follow up Long enough 3 months and 80 80, Based on the study design and risk of bias a level Healthcare Improvement CBO Table 2 Prospective. of evidence was given to every study according to the cohort trials of sufficient size and follow up that have. 2005 classification system of the Dutch Institute for adequately controlled for confounding and selective. 248 www painphysicianjournal com, Is Traumatic and Non traumatic Neck Pain Associated with Brain Alterations.
follow up is sufficiently excluded obtained a level of Study Characteristics. evidence A2 while cohort studies not meeting these The characteristics of each study were extracted. criteria or case control studies obtained a level of and presented in the evidence table Table 4 Four. evidence B Non controlled trials and expert opinions studies reported on structural brain alterations in. obtained a level of evidence C and D respectively neck pain patients 47 50 using a different MRI pro. tocol One study reported on changes in BOLD signal. Strength of Conclusion through task related fMRI imaging 51 another one. Subsequently the strength of conclusion ranging reported on alterations in neurotransmission through. from 1 to 4 was calculated for each cluster of studies PET imaging 52 and 6 studies analyzed perfusion. reflecting one outcome parameter Table 3 and was and or metabolism via PET or SPECT imaging using. placed between brackets in the results section Strength radiopharmaceutical tracers 53 58 The average age. of conclusion 1 was assigned for a study of level A1 or SD of the total patient and control sample when. at least 2 independently conducted studies of level available was 36 41 11 52 years and 33 0 12 21. A2 Strength of conclusion 2 was given when at least years respectively In total 75 n 179 of the study. INP with newer and more sensitive techniques and associative clinical measurements seem indispensable in future research Key words Traumatic neck pain idiopathic non traumatic neck pain brain alterations magnetic resonance imaging single photon emission computed tomography photon emission tomography chronic neck pain

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