Neurophysiology of Whiplash Pain

颈部挥鞭样损伤相关疾病（WAD）是一种常见且使人衰弱的疾病，通常没有客观的临床表现。它们发生在机动车撞击时，头部落后于加速的躯干，颈部承受负荷。它们可能发生在正面，侧面和后方的影响，但大多数投诉发生后，追尾碰撞的另一辆车。由于在临床检查和诊断测试中缺乏明显的组织损伤，因此与这种损伤相关的疼痛和随后的诉讼通常被认为是不合理的或精神疾病的表现。另一方面，未确诊的软组织损伤 临床上可能是颈部扭伤后疼痛的来源。最近的临床和生物力学研究暗示小关节可能是挥鞭样损伤后疼痛的主要来源。本研究的目的是确定颈椎小关节的疼痛感受器（疼痛感受器）是否是挥鞭样疼痛的来源。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.确定颈椎小关节伤害感受器和机械感受器对低速率和高速率负荷的反应。 2.目的：观察椎旁肌对小关节囊低速和高速染色的反应。 3.确定人类颈椎小关节囊的形态，包括关节的腹侧和滑膜皱襞。 4.确定神经和神经末梢在人体小关节囊内的分布，重点是前部， 滑膜褶皱免疫细胞化学将用于鉴定2？含有P物质（SP）和降钙素基因相关的神经 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).