1. 2014;17;265-274Cervical Radiofrequency Neurotomy Reduces Psychological Features in Individuals with Chronic Whiplash Symptoms
   Observational Study
   Ashley D Smith, PT, Gwendolen Jull, PT, PhD, Geoff Schneider, PT, PhD, Bevan Frizzell, MD, Robert Allen Hooper, MD, Rachel Dunne-Proctor, PhD, and Michele Sterling, PhD.

BACKGROUND: Individuals with chronic whiplash associated disorder (WAD) demonstrate various psychological features. It has previously been demonstrated that cervical radiofrequency neurotomy (cRFN) resolves psychological distress and anxiety. It is unknown if cRFN also improves or reduces a broader spectrum of psychological substrates now commonly identified in chronic whiplash, such as post-traumatic stress disorder (PTSD) and pain catastrophizing.

OBJECTIVES: To determine if reducing pain in the cervical spine (following cRFN) significantly reduces psychological features (distress, pain catastrophizing and post-traumatic stress symptoms) in individuals with chronic WAD.

SETTING:  Tertiary spinal intervention centre in Calgary, Alberta, Canada.

STUDY DESIGN: Prospective observational study of consecutive patients.

METHODS: Patients: Fifty-three individuals with chronic whiplash associated disorder symptoms (Grade 2). Intervention: Cervical RFN following successful response to cervical facet joint blockade. Measures were made at 4 time points: 2 prior to RFN, and 1-month and 3-months post-RFN. Psychological measures included the General Health Questionnaire (GHQ-28); Pain Catastrophizing Scale (PCS) and the Post Traumatic Stress Diagnostic Scale (PDS). Self-reported pain (VAS) and disability (NDI) measures were also collected.

RESULTS: Pain, disability, psychological distress and pain catastrophization significantly decreased at both 1-month and 3 months following cervical RFN. There was no significant change in post-traumatic stress symptom severity (P = 0.39). Reducing pain via cRFN was associated with significant improvement in psychological distress and pain catastrophizing, but not posttraumatic stress symptoms.

LIMITATIONS: Individual administering questionnaires was not blinded to aim(s) of the study. Other psychological features possibly present in WAD were not measured.

CONCLUSION: Effective pain relief would seem a crucial element in the management of psychological features associated with chronic WAD.

IRB Approval: University of Calgary Conjoint Health Research Ethics Board ID#: E-22082.