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Pain and disability in the jaw and neck regions after whiplash trauma: a short- and long-term perspective
Umeå University, Faculty of Medicine, Department of Odontology.ORCID iD: 0000-0002-7431-9618
2018 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Smärta och dysfunktion i käk- och nackregionerna efter whiplashtrauma : ett kort- och långtidsperspektiv (Swedish)
Abstract [en]

Whiplash trauma, a hyperextension-flexion trauma to the neck that is often related to a car accident, affects tens of thousands in Sweden every year. A significant proportion will develop long-term symptoms including neck pain and dysfunction – this is embraced as Whiplash associated disorders (WAD). Some individuals also develop pain and dysfunction in the orofacial region that is denoted as Temporomandibular disorder (TMD). TMD is common in the population with a prevalence of about 10% but the relation to whiplash trauma is still unclear. The limited number of prospective studies on TMD after whiplash trauma show diverging results, but it has been suggested that TMD develops over time and not in close proximity to the trauma. Prospective studies are needed to determine the course of jaw pain and disability after whiplash trauma.

The general aim of this thesis was to evaluate the presence and course of pain and disability in the jaw and neck regions at the acute and chronic stages after whiplash trauma.

This prospective cohort study included at baseline 176 cases with a recent whiplash trauma, and 116 age and gender matched controls without a history of neck trauma that were recruited from the general population. The cases had visited the emergency department at Umeå university hospital, Sweden, with neck pain within 72 hours following a car accident and had been diagnosed with neck distortion by a physician. The cases were examined within one month after the trauma (December 2010 to January 2016) and at a 2-year followup (December 2012 to January 2018). All participants completed questionnaires regarding pain and disability in the jaw and neck regions, physical symptoms (pain and non-pain items), and depression. At baseline, 80 of the cases and 80 of the controls also completed a 5-minute chewing capacity test. At the 2- year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined with the same questionnaires.

Compared to controls, within one month after a whiplash trauma cases reported significantly more pain in the jaw and neck regions with a positive correlation between the intensity of pain in these regions (Paper I). In the acute stage after trauma, cases, compared to controls, showed a reduced chewing capacity, and this was related to the severity of neck disability (Paper II). For cases, jaw and neck pain correlated positively to each other, to non-specific physical symptoms, and to depression at both the acute (Paper III) and chronic stages (Paper IV). About one third (34%) of the cases reported orofacial pain at baseline, and for a majority of these, the pain persisted at the 2-year follow-up (Paper IV).

The presence of orofacial pain early after a whiplash trauma indicates involvement of central sensitization and spread of pain between the jaw and neck regions. The positive correlations between pain in the jaw and neck regions, and to psychosocial factors, underline the integration of these regions and the importance of a biopsychosocial perspective. The impaired jaw function shortly after a neck trauma further underlines the close sensorimotor relationship between the trigeminal and cervical regions. The finding that orofacial pain is common shortly after whiplash trauma, and often persists into the chronic stage, indicates that assessment in the acute stage should include both the neck and jaw regions. From this, it follows that multidisciplinary teams that entail both medical professions and dentists specialised in orofacial pain can be beneficial in the early assessment after whiplash trauma.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2018. , p. 68
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 141
Keywords [en]
Jaw pain, Neck Pain, Neck disability, Orofacial pain, Psychosocial factors, Temporomandibular disorders, TMD, Temporomandibular joint, TMJ, Whiplash injury
National Category
Dentistry
Research subject
Odontology
Identifiers
URN: urn:nbn:se:umu:diva-153181ISBN: 978-91-7601-953-5 (print)OAI: oai:DiVA.org:umu-153181DiVA, id: diva2:1261790
Public defence
2018-11-30, Sal B, 9 tr, byggnad 1D, Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-11-09 Created: 2018-11-08 Last updated: 2022-11-29Bibliographically approved
List of papers
1. Pain and Disability in the Jaw and Neck Region following Whiplash Trauma
Open this publication in new window or tab >>Pain and Disability in the Jaw and Neck Region following Whiplash Trauma
2016 (English)In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 95, no 10, p. 1155-1160Article in journal (Refereed) Published
Abstract [en]

The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P < 0.0001) and group 2 (r = 0.59, P < 0.0001). In the logistic regression analysis, cases showed higher odds ratios (range, 6.1 to 40.8) for jaw and neck pain and disability compared with controls. Taken together, the results show that individuals with a recent whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain.

Keywords
myofascial pain, neurophysiology, neuroscience/neurobiology, orofacial pain/TMD, risk factor(s), mporomandibular disorders/TMD
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-126320 (URN)10.1177/0022034516653598 (DOI)000382310400011 ()27307051 (PubMedID)2-s2.0-84983247621 (Scopus ID)
Available from: 2016-11-02 Created: 2016-10-03 Last updated: 2023-03-24Bibliographically approved
2. Effects on jaw function shortly after whiplash trauma
Open this publication in new window or tab >>Effects on jaw function shortly after whiplash trauma
2017 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 44, no 12, p. 941-947Article in journal (Refereed) Published
Abstract [en]

Normal jaw function involves muscles and joints of both jaw and neck. A whiplash trauma may disturb the integrated jaw-neck sensory-motor function and thereby impair chewing ability; however, it is not known if such impairment is present shortly after a neck trauma or develops over time. The aim was to evaluate jaw function after a recent whiplash trauma. Eighty cases (47 women) were examined within 1 month after a whiplash trauma and compared to 80 controls (47 women) without neck trauma. Participants completed the Jaw disability checklist (JDC) and Neck Disability Index (NDI) questionnaires and performed a 5-minute chewing test. Elicited fatigue and pain during chewing were noted, and group differences were evaluated with Fisher's exact test and Mann-Whitney U-test. Compared to controls, cases had higher JDC (P<.0001) and NDI scores (15% vs 2%, P<.0001), and reported more fatigue (53% vs 31%, P=.006) and pain (30% vs 10%, P=.003) during the chewing test. Cases also had a shorter onset time for fatigue and pain (both P=.001) Furthermore, cases reporting symptoms during chewing had higher JDC and NDI scores compared to cases not reporting symptoms (both P=.01). Symptoms mainly occurred in the trigeminal area for both groups, but also in spinal areas more often for cases than for controls. Taken together, the results indicate that jaw-neck sensory-motor function is impaired already within 1month after a whiplash trauma. The association between neck disability and jaw impairment underlines the close functional relationship between the regions, and stresses the importance of multidisciplinary assessment.

Place, publisher, year, edition, pages
WILEY, 2017
Keywords
accidents, facial pain, mastication, neck pain, temporomandibular joint dysfunction syndrome, traffic, iplash injuries
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-142232 (URN)10.1111/joor.12571 (DOI)000414577300003 ()28891205 (PubMedID)2-s2.0-85032881708 (Scopus ID)
Available from: 2017-12-11 Created: 2017-12-11 Last updated: 2024-01-17Bibliographically approved
3. Relationship Between Psychosocial Factors and Pain in the Jaw and Neck Regions Shortly After Whiplash Trauma
Open this publication in new window or tab >>Relationship Between Psychosocial Factors and Pain in the Jaw and Neck Regions Shortly After Whiplash Trauma
2019 (English)In: Journal of Oral & Facial Pain and Headache, ISSN 2333-0384, Vol. 33, no 2, p. 213-219Article in journal (Refereed) Published
Abstract [en]

Aims: To assess jaw pain shortly after whiplash trauma in relation to neck pain, physical symptoms, depression, and jaw pain-related disability.

Methods: A total of 181 cases (106 women and 75 men, mean ages 33.7 and 36.8 years, respectively) were examined within 1 month after a whiplash trauma and compared to 117 controls (68 women and 49 men, 34.2 and 30.9 years, respectively). Participants rated current jaw and neck pain intensity on a numeric rating scale and rated nonspecific physical symptoms and depression symptoms on subscales of the Symptom Checklist-90-Revised. The nonspecific physical symptoms were further analyzed with and without pain items. Disability related to jaw pain and neck pain was also assessed. Differences between groups were calculated using Mann-Whitney U test, and correlations were measured using Spearman correlation.

Results: Compared to controls, cases reported higher current jaw and neck pain intensity (P < .0001), together with higher scores for physical nonpain and pain symptoms, depression, and jaw pain-related disability (P < .0001 for all). For cases, there were moderate correlations between nonspecific physical symptoms and jaw pain and neck pain, as well as between jaw pain-related disability and jaw pain and neck pain (r = 0.43 to 0.77, P < .0001 for all). Low correlations were observed between depression and jaw pain and neck pain (r = 0.34 to 0.39, both P < .0001).

Conclusion: Shortly after a whiplash trauma, pain in the jaw and neck regions is associated with the severity of psychosocial factors. Thus, psychosocial factors may play a role in the development of pain in the jaw region after whiplash trauma.

Place, publisher, year, edition, pages
Quintessence Publishing Co., Inc., 2019
Keywords
jaw, pain, psychosocial factors, temporomandibular disorders, whiplash injury
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-153178 (URN)10.11607/ofph.2226 (DOI)000468359000010 ()30371684 (PubMedID)2-s2.0-85065219390 (Scopus ID)
Funder
The Kempe FoundationsVästerbotten County Council
Available from: 2018-11-08 Created: 2018-11-08 Last updated: 2022-11-29Bibliographically approved
4. The Course of Orofacial Pain and Jaw Disability after Whiplash Trauma: A 2-year Prospective Study
Open this publication in new window or tab >>The Course of Orofacial Pain and Jaw Disability after Whiplash Trauma: A 2-year Prospective Study
Show others...
2020 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 45, no 3, p. E140-E147Article in journal (Refereed) Published
Abstract [en]

Study Design: Prospective cohort study.

Objective: To evaluate the course of orofacial pain and jaw disability in relation to neck pain, neck disability and psychosocial factors at the acute stage and the chronic stage after whiplash trauma.

Summary of Background Data: Many individuals report chronic pain in the orofacial region after whiplash trauma. The possible association between whiplash trauma and orofacial pain is debated. Prospective studies are therefore needed to evaluate the development of orofacial pain after whiplash trauma.

Methods: Within one month following a whiplash trauma, 176 cases were examined and compared to 116 controls with questionnaires concerning neck and jaw pain and related disability, non-specific physical symptoms and depression. At the 2-year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined.

Results: Compared to controls, cases reported more jaw and neck pain, both at baseline and follow-up. A majority (68%) of cases with pain in the jaw region in the acute stage also reported jaw pain at the follow-up. The intensity of jaw and neck pain was correlated both at baseline and follow-up. Both neck pain and jaw pain was correlated to non-specific physical symptoms and to depression.

Conclusion: Orofacial pain and jaw disability related to neck pain is often present already at the acute stage after whiplash trauma and persist into the chronic stage for most individuals. Assessment following whiplash trauma should therefore include both the neck and the orofacial regions. More studies are needed to further evaluate risk factors for development of orofacial pain after whiplash trauma.

Level of Evidence: 3

Place, publisher, year, edition, pages
Wolters Kluwer, 2020
Keywords
Jaw pain, Neck Pain, Neck disability, Orofacial pain, Psychosocial factors, Temporomandibular disorders, TMD, Temporomandibular joint, TMJ, Whiplash injury
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-153180 (URN)10.1097/BRS.0000000000003212 (DOI)000545584900003 ()31513116 (PubMedID)2-s2.0-85072222876 (Scopus ID)
Funder
The Kempe FoundationsRegion Västerbotten
Note

Originally included in thesis in manuscript form.

Available from: 2018-11-08 Created: 2018-11-08 Last updated: 2022-11-29Bibliographically approved

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