Why Does Acute Post Whiplash Injury Pain Transform Into Chronic Pain? Multi-modal Assessment of Risk Factors and Predictors of Pain Chronification

Background

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. Based on the clinical and psychological assessment along with psychophysical and neurophysiological assessment of pain perception, with the analysis of connectivity between several brain centers relevant for pain processing, together with pain genetics, we expect to develop a tool, 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.

Our specific aims are to evaluate, in the setup of acute whiplash injury, the risk of transition to chronic pain based on each of the following testing domains: (i) Psychophysical and neurophysiological data describing facilitatory and inhibitory modulation capacity of the patient. (ii) Psychological data describing patient's behavior such as catastrophizing, fear of pain, post-traumatic stress and depressed mood. (iii) Structural and functional neuro-imaging data describing brain anatomy and function, where we assess resting state MRI activity, grey matter properties using T1 weighted imaging, and white matter properties using diffusion tensor imaging. (iv) Genetic data describing the genetic epidemiology of every patient for the examination of genetic variants associated with transition to chronic pain, and (v) individual case data related to age, gender, education, socioeconomic parameters and personal medical history, as well as features of the specific injury. Overall, we aim to construct a composite scoring system, based on the most relevant of the above mentioned parameters, yielding the highest relative predictive value in identifying acute pain patients who have higher risk for chronification.

Subjects One hundred and twenty healthy subjects (range 20-79; 20 subjects per age decade, 10 M and 10 F) will participate in the first phase of the study aimed to collect normative data from healthy population.

Seven hundred and fifty acute whiplash-injury based mild traumatic brain injuries (TBI) will participate in this study.