Frequent jaw-face pain in chronic Whiplash-Associated Disorders
From: Swed Dent J. 2011;35(3):123-31
Chronic Whiplash Associated Disorders present with frequent pain in the neck, head and shoulder regions but the presence of frequent jaw-face pain is unclear. The aim of the study was to investigate the frequency of jaw-face pain, pain in other regions, and general symptoms in chronic whiplash associated disorders patients.
Fifty whiplash patients and 50 healthy age and gender matched controls were examined by questionnaire for pain in the jaw-face, pain in other regions and other symptoms. In contrast to healthy, a majority of the whiplash associated disorders patients (88%) reported frequent pain in the jaw-face, in addition to frequent pain in the neck (100%), shoulders (94%), head (90%) and back (72%). The whiplash associated disorders patients also reported stiffness and numbness in the jaw-face region, and frequent general symptoms such as balance problems, stress and sleep disturbances.
The result suggests that frequent pain in the jaw-face can be part of the spectrum of symptoms in chronic whiplash associated disorders. The finding of self-reported numbness in the jaw-face indicates disturbed trigeminal nerve function and merits further investigation. The authors conclude that assessment of whiplash associated disorders should include pain in the jaw-face region. A multidisciplinary rehabilitation program including dentists, preferably specialized in the area of orofacial pain, should be advocated after whiplash injury.
Doubtful nosological validity of the chronic whiplash syndrome
From: Orthopade. 2011 Nov 30. [Epub ahead of print]
Since the 1980s, victims of traffic accidents in western countries increasingly report chronic symptoms which they attribute to a whiplash injury of the cervical spine. In an extensive review article published in 1996, it was, however, concluded that this so-called chronic whiplash syndrome has little nosological validity. It was now investigated whether this conclusion could be upheld by the results of later published studies.
Extensive evaluation was carried out of all the whiplash literature listed in Pubmed since 1996 with the question whether research over the last 15 years has achieved a better validation of this syndrome. Of the over 1,600 publications about whiplash since 1996, no study could be identified which confirmed the nosological validity of the chronic whiplash syndrome.
As a positive consequence of the results of this study, accident victims suffering whiplash can be informed about the very good prognosis after whiplash in a more trustworthy way. Many iatrogenic injuries can thus be avoided. The expert opinion after whiplash without radiologically documented and/or neurologically confirmed significant acute traumatic injury which can cause chronic symptoms, should generally not be in favor of insurance benefits. The authors propose that all of a set of minimal criteria should be fulfilled if in exceptional cases a probable relationship between the trauma and chronic symptoms can be assumed.
Does tinnitus distress depend on age of onset?
From: PLoS One. 2011;6(11):e27379
Tinnitus is the perception of sound in the absence of an auditory stimulus. Averaged over all age groups 5–15% of the western population experience some form of tinnitus. Many people can cope with chronic tinnitus, but about 1–2% of the population experience significant impairments in their quality of life due to their tinnitus.
The prevalence of chronic tinnitus increases with increasing age, peaking at 14.3% in people between 60 and 69 years of age. The increase in tinnitus prevalence with age is at least partly explained by the fact that hearing loss is an important risk factor for tinnitus and hearing loss prevalence also increases with age.
Neuroplastic processes play a crucial role both in the generation of tinnitus and in the amount of suffering. Imaging studies reveal that neuroplastic changes in the central auditory system are generating the tinnitus percept and that coactivation of nonauditory structures in the frontal cortex and the limbic system are involved in tinnitus related distress.
Studies in animals and humans have shown that the mechanisms of cortical plasticity change over the lifetime with a tendency of decreased and less efficient neuroplastic potential as demonstrated by decreased induction and maintenance of long-term-potentiation and reduced long-term depression-like effects with advancing age.