title: Measures of central hyperexcitability in chronic whiplash associated disorder--a systematic review and meta-analysis.
abstract: OBJECTIVE
  To synthesise the evidence for central hyperexcitability in Chronic WAD (whiplash associated disorders) with meta-analysis, and review test protocols.
  
  
  METHODS
  Chronic WAD was compared to healthy controls. Studies were eligible if they used measures of central hyperexcitability with standardised procedure. Meta-analyses (where possible) were conducted.
  
  
  RESULTS
  The search yielded 27 trials of good quality and 13 were suitable for meta-analyses. Individuals with chronic WAD showed heightened sensitivity to the following tests (p < 0.05): Pressure Pain Thresholds at Head/Neck/Upper Thoracic area (H/N/UT) (SMD (Standardised mean differences) -1.36, 95% CI (confidence intervals) -1.89 to -0.82), Upper Limb (UL) (-1.33, 95% CI -2.50 to -0.16), Lower Limb (LL) (-1.01, 95% CI -1.70 to -0.33), flexor withdrawal (-0.73, 95% CI -1.11 to -0.35), Cold Pain Threshold at H/N/UT (0.91, 95% CI 0.66-1.17) and UL (0.66, 95% CI 0.37-0.94), Heat Pain Threshold at H/N/UT (-0.58, 95% CI -0.88 to -0.28), Electrocutaneous Stimulation at H/N/UT (-1.04, 95% CI -1.63 to -0.45) and LL (-0.85, 95% CI -1.67 to -0.03), and elbow extension with the Brachial Plexus Provocation Test (SMD -0.55, 95% CI -0.76 to -0.35).
  
  
  CONCLUSIONS
  There is compelling evidence for central hyperexcitability in chronic WAD. This should be considered in the management of chronic WAD.
authors.affiliation: Centre of National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Edith Cavell Building, RBWH, Herston Qld 4029, Australia.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Stone
authors.forename: Bill
authors.initials: B
authors.lastname: Vicenzino
authors.forename: Edwin C W
authors.initials: EC
authors.lastname: Lim
authors.forename: Michele
authors.initials: M
authors.lastname: Sterling
mesh_terms: D002574:Cervical Vertebrae / Q000503:physiopathology; D002908:Chronic Disease; D004185:Disability Evaluation; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology / Q000503:physiopathology; D009619:Nociceptors / Q000502:physiology*; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology*; D010812:Physical Stimulation / Q000379:methods; D011595:Psychomotor Agitation / Q000209:etiology / Q000503:physiopathology; D011984:Sensory Receptor Cells / Q000502:physiology*; D014911:Whiplash Injuries / Q000150:complications* / Q000503:physiopathology*