Modern pain neuroscience applied to chronic pain in patients with whiplash associated disorders: Can we decrease central sensitization?

Modern pain neuroscience has advanced our understanding of chronic whiplash associated disorders (WAD). Previous studies have shown the importance of central sensitization, characterized by hypersensitivity of the somatosensory system, in explaining poor treatment outcome. Therefore, and to address the need for a better treatment of WAD, we recently proposed a modern neuroscience approach to WAD. Such approach includes two specific parts: 3 sessions of therapeutic pain neuroscience education followed by 15 sessions of cognition-targeted motor control training. The study aims at examining the effectiveness of a modern neuroscience approach vs. evidence-based physiotherapy for reducing pain, dysfunctioning and central sensitization in patients with WAD. The trial will randomise 120 patients with WAD to the experimental (modern neuroscience approach) or control treatment (usual care physiotherapy: 3 sessions of neck school + 15 sessions of exercise therapy). The primary outcome measures are pain and functional status. Secondary outcomes include (psycho)physiological measures of central sensitization, including electrophysiological assessment of thermonociceptive pathways using Contact Heat-Evoked Potentials (CHEPS) and scalp electroencephalography (EEG), and psychological variables. Follow-up assessments will be performed after nine sessions of intervention, 3 months, 6 months and 12 months after baseline assessment.