Depression may contribute to the sensory changes in whiplash patients? Re: Chien, A, Sterling, M. Sensory hypoaesthesia is a feature of chronic whiplash but not chronic idiopathic neck pain. Manual therapy 2010;15:48–53

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Depression may contribute to the sensory changes in whiplash patients? Re: Chien, A, Sterling, M. Sensory hypoaesthesia is a feature of chronic whiplash but not chronic idiopathic neck pain. Manual therapy 2010;15:48–53

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  Letter to the Editor Depression may contribute to the sensory changes in whiplash patients? Re:Chien, A, Sterling, M. Sensory hypoaesthesia is a feature of chronic whiplash butnot chronic idiopathic neck pain. Manual therapy 2010;15:48–53. We read with great interest the recent paper by Chien and Ster-ling contrasting the sensory impairments of patients with chronicwhiplash and chronic idiopathic neck pain (Chien and Sterling,2010). Work from this group has previously provided invaluableinsight into the problem of whiplash and this paper is no exception.Inthisstudy,chronicwhiplashpatientsdemonstratedsensoryhypo-aesthesia whereas idiopathic neck pain patients did not, and whileboth patient groups had lowered pressure pain thresholds, onlythe whiplash group demonstrated lowered cold pain thresholds.We were struck by the similarity between the findings demon-strated in this study and prior research involving quantitativesensory testing in depressed patients. Adler and Gattaz (1993)have demonstrated increased sensory thresholds to electrical stim-ulationindepressedpatients.Baretal.(2003)foundsomeevidenceforelevatedwarmthdetectionthresholdsindepression,thoughthiswasdependentonmedicationstatus.Thisgroupalsodemonstratedthat hyperalgesia is modality specific; depressed patients wereshown to be more sensitive to ischemic pain yet less sensitive tothermal and electrical pain (Bar et al., 2005). Furthermore, Klauen- berg et al. (2008) recently reported decreased cold pain thresholdsbut normal mechanical pain thresholds in a group of pain freedepressed subjects. While the somatosensory abnormalitiesapparent in depression are still not fully described (Dickens et al.,2003) hypoaesthesia and modality specific hyperalgesia seem tobe consistent features. In the Chien and Sterling paper whiplashpatients demonstrated elevated depression scores when comparedtotheidiopathicneckpainpatientsanditmaybeworthconsideringthattheintriguingsetofsensoryimpairmentsfoundcouldinpartbeattributable to depressed mood and its associated central changes.Whiletheauthorscontrolledforpsychologicaldistressintheiranal-yses, the depression scores contributed only a small part to thisoverall score so minimising the efficiency of the analyses to controlfordepression. Given the apparent importance of depression in thedevelopment of ongoing pain and disability following whiplashinjury(Richteretal.,2004;Holmetal.,2007)amoresensitiveinter-rogation of this potential association may be indicated. References Adler G, Gattaz WF. Pain perception threshold in major depression. BiologicalPsychiatry 1993;34(10):687–9.Bar K-J, Brehm S, Boettger MK, Boettger S, Wagner G, Sauer H. Pain perception inmajor depression depends on pain modality. Pain 2005;117(1/2):97–103.Bar K-J, Greiner W, Letsch A, Kobele R, Sauer H. Influence of genderand hemisphericlateralization on heat pain perception in major depression. Journal of Psychi-atric Research 2003;37(4):345.Chien A, Sterling M. Sensory hypoaesthesia is a feature of chronic whiplash but notchronic idiopathic neck pain. Manual Therapy 2010;15:48–53.Dickens C, McGowan L, Dale S. Impact of depression on experimental pain percep-tion: a systematic review of the literature with meta-analysis. PsychosomaticMedicine 2003;65(3):369–75.Holm LW, Carroll LJ, Cassidy JD, Skillgate E, Ahlbom A. Widespread pain followingwhiplash-associated disorders: incidence, course, and risk factors. Journal of Rheumatology 2007;34(1):193–200.Klauenberg S, Maier C, Assion H-J, Hoffmann A, Krumova EK, Magerl W, et-al.Depression and changed pain perception: hints for a central disinhibitionmechanism. Pain 2008;140(2):332–43.Richter M, Ferrari R, Otte D, Kuensebeck HW, Blauth M, Krettek C. Correlation of clinical findings, collision parameters, and psychological factors in the outcomeof whiplash associated disorders. Journal of Neurology, Neurosurgery & Psychi-atry 2004;75(5):758–64. Benedict Martin Wand * The University of Notre Dame Australia, School of Health Sciences,19 Mouat Street, Fremantle, Western Australia 6959, Australia *  Tel.:  þ 61 8 9433 0203; fax:  þ 61 8 9433 0210. E-mail address:  bwand@nd.edu.au (B.M. Wand)Neil O’Connell Brunel University, Uxbridge, Middlesex, UK  Luke Parkitny Fremantle Hospital Pain Medicine Unit,Fremantle, WA, Australia Contents lists available at ScienceDirect Manual Therapy journal homepage: www.elsevier.com/math 1356-689X/$ – see front matter    2009 Elsevier Ltd. All rights reserved.doi:10.1016/j.math.2009.12.010 Manual Therapy 15 (2010) e1
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