• Tze Siong Ng, Ashley Pedler, Bill Vicenzino, and Michele Sterling.
• †Physiotherapy Section, Department of Rehabilitation, National University Hospital, Singapore, Singapore *Division of Physiotherapy, School of Health and Rehabilitation Sciences §Centre for Clinical Excellence in Spinal Pain, Injury and Health, Division of Physiotherapy, The University of Queensland, St Lucia ‡Centre of National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Herston, QLD, Australia.
• Clin J Pain. 2014 May 1;30(5):436-42.

ObjectivesCultural differences in pain perception exist. Although chronic whiplash-associated disorder (WAD) is well investigated in western countries, little is known about its presentation in Singapore. We studied the neck motion and pain sensitivity in people with chronic WAD in Singapore.Materials And MethodsThirty chronic WAD participants (>3 mo, Neck Disability Index: 40% [SD 17%]) were age, sex, and ethnicity matched with 30 pain-free controls. All 60 participants underwent the following tests: active neck motion, pain thresholds (pressure, brachial plexus provocation test [BPPT], cold), cold pain tolerance, and conditioned pain modulation (CPM). The test stimulus of contact heat and conditioning stimulus of cold water immersion was used to assess CPM. Data were evaluated to determine differences between WAD and control groups.ResultsActive neck motion (F1,29=80.02), pain thresholds of blunt pressure (F1,29=20.84), BPPT (F1,29=54.56), and cold (Z=-4.31) were significantly lower in participants with WAD (P<0.0001). Cold pressor pain tolerance was significantly lower in participants with WAD (Z=-2.89, P=0.02). A less efficacious CPM was also demonstrated in participants with WAD (F1,29=9.20, P=0.03). A combination of BPPT and cold hyperalgesia best predicted the WAD group (sensitivity=96.7%, specificity=96.7%).DiscussionThese findings of sensory hypersensitivity and decreased neck motion in Singaporeans with chronic WAD are consistent with physical impairments reported in western populations.

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