Neurobiological mechanisms underlying chronic whiplash associated pain: The peripheral maintenance of central sensitization

Objective: To review the current neurophysiologic basis for the chronic pai n experience, as it may apply to chronic whiplash. Findings: There appears to be a dichotomy in our understanding of the chron ic pain experience, and its cause. On the one hand, a simple physical tissu e trauma that has failed to heal, does not explain what is currently observ ed as chronic pain behavior. Psychological problems and/or secondary gain a re associated factors, suggesting the lack of a physical disorder. Recent f indings on the neural mechanisms of pain, indicate that there may be some i ndividuals whose traumatic event may have sensitized certain neurophysiolog ic processes to interpret as pain, from experiences of otherwise ordinary s ensory-perception events. These central sensitization events could be cause d or aggravated by various combinations of trauma, psychological disorders, or secondary gain and may provide at least a partial explanation of why so me persons may develop chronic pain, and others will not.