TY - JOUR T1 - Whiplash: Same Elephant, Different Room JF - The Journal of Rheumatology JO - J Rheumatol SP - 411 LP - 413 DO - 10.3899/jrheum.131541 VL - 41 IS - 3 AU - GEOFFREY OWEN LITTLEJOHN AU - EMMA K. GUYMER Y1 - 2014/03/01 UR - http://www.jrheum.org/content/41/3/411.abstract N2 - Musculoskeletal injury can cause acute pain and can also trigger chronic pain. The mechanisms resulting in these 2 outcomes are essentially different, with acute pain relating primarily to peripheral nociception and chronic pain relating primarily to central sensitization. Acute musculoskeletal pain usually resolves with time or treatment. Chronic pain, by definition, persists and associates with significant longterm health effects and diminished quality of life (QOL). Despite the importance of this problem, the issues surrounding persisting pain after injury remain controversial1. Aspects of postinjury pain and disability are addressed in this issue of The Journal through followup of persons involved in minor trauma from motor vehicle accidents2.The clinical features of patients with persisting pain after trauma, where the inciting lesion has resolved, are usually distinctive and embody a number of characteristic pain phenotypes. Central sensitization is the most prominent contributing mechanism3. Common examples are fibromyalgia (FM), regional pain syndrome, and complex regional pain syndrome (CRPS)4. These disorders are characterized by widespread or regionalized pain in a distribution that cannot be explained by an abnormality of a specific localized musculoskeletal or neural structure, be it in the periphery or in the spinal area. The pain may be segmental and often accompanied by unpleasant non-neuroanatomical sensory sensations within the same region. There is widespread or regional lowering of pain threshold elicited clinically by the determination of abnormal tenderness on palpation, more prominent in selected areas known as tender points. Muscular tightness, co-contraction, and development of trigger points are common. There is often mild soft tissue swelling and dermatographia, indicative of neurogenic inflammation. In CRPS more prominent vasomotor, sudomotor, muscle, and dystrophic features are present5.In addition to these physical signs, patients complain to a varying degree about sleep disturbance, fatigue, cognitive dysfunction, … Address correspondence to Dr. Littlejohn, Suite H, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia; E-mail: Geoff.littlejohn{at}monash.edu ER -