Neurophysiology of Whiplash Pain

颈部鞭打相关疾病(WAD)是常见的、使人衰弱的疾病，通常没有客观的临床表现。它们发生在机动车碰撞期间，当头部落后于加速的躯干，加载颈部。它们可以发生在正面、侧面和后面的碰撞中，但大多数投诉发生在与另一辆车追尾之后。由于在临床检查和诊断测试中没有明显的组织损伤，与这种损伤相关的疼痛和随之而来的诉讼通常被认为是不正当的或精神障碍的表现。另一方面，未确诊的软组织损伤 临床上可能是鞭打后疼痛的根源。最近的临床和生物力学研究表明，小关节可能是鞭打后疼痛的主要来源。这项研究的目的是确定颈椎关节面膏中的痛觉感受器(疼痛感受器)是否可以成为鞭打疼痛的来源。组织学、神经生理学和生物力学技术已被利用。 具体目标： 这项研究第二阶段的具体目标是： 1.测定颈椎小关节伤害性感受器和机械感受器对低速率和高速率负荷的反应。 2.测定椎旁肌对低、高比率小关节囊染色的反应。 3.测量人颈椎小关节囊的形态，包括关节腹侧和滑膜皱褶。 4.确定人小关节囊内神经及神经末梢的分布，重点在关节囊的前部和周围。 滑膜皱折。将采用免疫细胞化学方法鉴定2？P物质(SP)神经与降钙素基因相关 降钙素基因相关肽(CGRP)、与疼痛相关的神经肽和β淀粉样前体蛋白(β-APP)。

Whiplash associated disorders (WAD) to the neck are common and debilitating, and often without objective clinical findings. They occur during a motor vehicle impact when the head lags behind the accelerated torso, loading the neck. They can occur in frontal, side and rear impacts but most complaints occur after a rear-end collision by another vehicle. Because of the lack of obvious tissue damage upon clinical examination and diagnostic testing, the pain and ensuing litigation associated with this injury are often considered unjustified or the manifestation of a psychiatric disorder. On the other hand, soft tissue injuries which are undiagnosed clinically may be the source of pain after whiplash. Recent clinical and biomechanical studies implicate the facet joints as perhaps the major source of pain after whiplash. The purpose of this study is to determine ifnociceptors (pain receptors) in the cervical facet oints can be a source of whiplash pain. Histological, neurophysiological and biomechanical techniques have been utilized. Specific Aims: The specific aims of the second phase of this study are: 1. To determine the response of cervical facet nociceptors and mechanoreceptors to low-rate versus high-rate loading. 2. To determine the response ofparaspinal muscles to low-rate and high-rate facet capsule stain. 3. To determine the morphology of the human cervical facet joint capsules, including the ventral aspect of the joint and synovial folds. 4. To determine the distribution of nerves and nerve endings in the human facet joint capsule, with focus on anterior aspects and synovial folds. Immunocytochemistry will be used to identif2? nerves containing substance P (SP) and calcitonin gene related peptide (CGRP), neuropeptides associated with pain and beta amyloid precursor protein betaAPP).