Why Does Acute Postwhiplash Injury Pain Transform into Chronic Pain? Multimodal Assessment of Risk Factors and Predictors of Pain Chronification
Abstract
The proposed study aims to explore why acute pain turns, in some patients, into chronic pain, and to develop tools for prediction of this transition. As a consequence of the study, it will become possible to tailor treatment programs to at-risk acute pain patients in order to prevent their transition to chronic pain. The study population is whiplash injury patients who will be recruited upon arrival to the emergency room. Patients will undergo a comprehensive assessment that will include: (a) clinical and psychological assessment; (b) measurement of how they process experimental pain, using complex stimulation paradigms that were shown to reflect and predict internal pain processing; (c) recording of electrical brain activity at rest and in response to a variety of painful stimuli; (d) MRI (magnetic resonance imaging) sequences of imaging that explore the gray matter, white matter, and connectivity between several brain centers relevant for pain processing; and (e) genetic assessment of the whole genome, including genes already known to be relevant for pain processing, and searching for new ones not yet described in this context. The study will recruit 750 patients, number calculated to be sufficient for conclusion drawing based on the relatively large number of variables measured. Recruitment will be along 1.5 years, and study will be completed within 3 years. We will follow the patients for 1 year and identify those that became chronic pain and those that recovered. The analysis of data will join forces of world leading experts in the various lines -- Yarnitsky s group for pain processing measurement, Sterling s for the psychology of whiplash, Apkarian s for analysis of pain-related MRI imaging data, and Belfer/Maixner/Diatchenko s for the genetics of pain. We expect to develop a tool, based on the above-mentioned lines, that will predict, for the individual patient with acute pain inflicted by a whiplash injury, what are the chances for him/her to go into chronic pain situation. Further, by knowing the dysfunctions of pain processing that a patient has, it will be possible to offer the treatment of highest chances to succeed. For example, we know that patients whose pain inhibition capacity is less efficient will benefit more from analgesic agents that augment this capacity. We foresee several lines of coupling between dysfunctions at baseline and appropriate remedies for their repair. We also expect that the results of this study will be applicable, at small additional effort, to other pain syndromes, since the brain s pain processing bears similar, though not identical, principles for the various painful body parts and pain syndromes. In the military context, the immediate results will be better understanding and better delineation of treatment policy for acute head injuries. Knowing who is likely to become a chronic pain sufferer and identifying the specific deficient pain processing mechanism of this patient will allow concentration of therapeutic efforts on this patient, in an attempt to prevent chronification. Further, the same rationale of treating the dysfunctional pain processing mechanism can also benefit patients already at the chronic pain stage.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Apr 04, 2016
- Source ID
- W81XWH1510603
Entities
People
- David Yarnitsky
Organizations
- Technion – Israel Institute of Technology
- United States Army