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Neural processing of pain-related distress to neck-specific movements in people with chronic whiplash-associated disorders.

  • Murillo, Carlos1, 2
  • Coppieters, Iris1, 2, 3, 4
  • Cagnie, Barbara1
  • Bernaers, Lisa1
  • Bontinck, Jente1, 2
  • Meeus, Mira1, 2, 5
  • Timmers, Inge1, 6, 7
  • 1 Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Ghent, Belgium. , (Belgium)
  • 2 Pain in Motion International Research Group, Antwerp, Belgium. , (Belgium)
  • 3 Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research in GastroIntestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism, Faculty of Medicine, KU Leuven, Belgium. , (Belgium)
  • 4 Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium. , (Belgium)
  • 5 MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences and Medicine, University of Antwerp, Antwerp, Belgium. , (Belgium)
  • 6 Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands. , (Netherlands)
  • 7 Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Maastricht, the Netherlands. , (Netherlands)
Published Article
Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins
Publication Date
Sep 01, 2023
DOI: 10.1097/j.pain.0000000000002890
PMID: 36943244


Pain-related distress contributes to long-term disability in chronic whiplash-associated disorders. Recently, neuroimaging studies have revealed altered neural responses to viewing pictures of movements associated with back pain in key regions for threat and affective processing. In this study, we examined neural correlates of imagining neck-specific movements designed to elicit pain-related distress in individuals with whiplash-associated disorders (n = 63) when compared with that in sex-matched pain-free controls (n = 32). In the scanner, participants were presented with neck-specific movement-related pictures divided into 3 categories (high fear, moderate-fear, and neutral control pictures) and asked to imagine how they would feel if they were performing the movement. Whole-brain analyses revealed greater differential activation (high-fear vs neutral) in individuals with whiplash-associated disorders when compared with that in pain-free controls in 6 clusters including right and left postcentral gyri, left parietal operculum, dorsal precuneus, left superior frontal gyrus/anterior cingulate cortex, and posterior cingulate cortex/ventral precuneus. For the contrast moderate-fear vs neutral, patients showed greater differential activation than controls in the right and left posterolateral cerebellum. Activation patterns in the precuneus and posterior cingulate cortex were negatively associated with pain-related fear, but no other correlations were observed. Together, the findings suggest that when conceptualizing neck-specific movements associated with pain, people with chronic whiplash-associated disorders may predict-and potentially amplify-their sensory and affective consequences and therewith trigger dysfunctional affective and/or behavioral responses. Herewith, we provide new insights into the neural mechanisms underlying chronic pain in people with whiplash-associated disorders, pointing towards a complex interplay between cognitive/affective and sensorimotor circuitry. Copyright © 2023 International Association for the Study of Pain.

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