The effect of steroid treatment on whiplash associated syndrome: a controlled randomized prospective trial.
Cortisol
Neck injury
PTSD
Steroids
Trauma
Whiplash
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
22
09
2019
accepted:
02
12
2019
pubmed:
8
12
2019
medline:
16
10
2021
entrez:
8
12
2019
Statut:
ppublish
Résumé
There is significant evidence in the literature that low or relatively low cortisol concentrations near the time of an accident are associated with more severe forms of whiplash-associated disorders. We hypothesized that treating patients that were involved in a motor vehicle accident with hydrocortisone would alleviate the incidence and severity of these disabling disorders. A prospective, randomized, double-blind, placebo-controlled clinical trial. Blunt trauma patients that underwent a motor vehicle crash were allocated into a study group that received a single bolus of hydrocortisone and a control group that received saline. The patients were followed for 1 month. The incidence and severity of whiplash associated disorder, functional disturbances, and post-traumatic stress disorder were compared between the two groups. The analyses were repeated for sub-divisions into groups of high and low admission cortisol. The more severe forms of whiplash-associated disorders on the day of accident were associated with low cortisol levels; mean cortisol concentration of the lower grade of whiplash patients (13.09 ± 7.35 µg%) was higher than that of whiplash syndrome of the severe forms (8.33 ± 3.45 µg), p = 0.001. There were no differences between study and control groups regarding whiplash-associated disorders, functional tests, and severity of stress disorder 1 month after the accident. Significant differences were evident between high and low cortisol sub-groups. Those who had low cortisol level on admission and received hydrocortisone had worse outcomes. Steroid treatment of patients with whiplash might be harmful to those who present with low cortisol concentrations (< 9.5 μg/dL). Clinical Trials: Association between low cortisol levels and whiplash syndrome. Date of registration: March 18, 2014. Date the first participant was enrolled: May 10, 2014. NCT02090309. URL: https://clinicaltrials.gov/ct2/show/NCT02090309 .
Identifiants
pubmed: 31811333
doi: 10.1007/s00068-019-01282-3
pii: 10.1007/s00068-019-01282-3
doi:
Substances chimiques
Hydrocortisone
WI4X0X7BPJ
Banques de données
ClinicalTrials.gov
['NCT02090309']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1115-1122Informations de copyright
© 2019. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Bylund PO, Bjornstig U. Sick leave and disability pension among passenger car occupants injured in urban traffic. Spine (Phila Pa 1976). 1998;23:1023–8.
doi: 10.1097/00007632-199805010-00012
Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine (Phila Pa 1976). 1995;20:1S–73S.
doi: 10.1097/00007632-199504151-00001
Panjabi MM, Cholewicki J, Nibu K, Grauer JN, Babat LB, Dvorak J. Mechanism of whiplash injury. Clin Biomech (Bristol, Avon). 1998;13:239–49.
doi: 10.1016/S0268-0033(98)00033-3
Croft AC, Herring P, Freeman MD, Haneline MT. The neck injury criterion: future considerations. Accid Anal Prev. 2002;34:247–55.
doi: 10.1016/S0001-4575(01)00020-3
Brault JR, Siegmund GP, Wheeler JB. Cervical muscle response during whiplash: evidence of a lengthening muscle contraction. Clin Biomech (Bristol, Avon). 2000;15:426–35.
doi: 10.1016/S0268-0033(99)00097-2
Giannoudis PV, Mehta SS, Tsiridis E. Incidence and outcome of whiplash injury after multiple trauma. Spine (Phila Pa 1976). 2007;32:776–81.
doi: 10.1097/01.brs.0000259223.77957.76
Ferrari R, Schrader H. The late whiplash syndrome: a biopsychosocial approach. J Neurol Neurosurg Psychiatry. 2001;70:722–6.
doi: 10.1136/jnnp.70.6.722
McLean SA, Clauw DJ, Abelson JL, Liberzon I. The development of persistent pain and psychological morbidity after motor vehicle collision: integrating the potential role of stress response systems into a biopsychosocial model. Psychosom Med. 2005;67:783–90.
doi: 10.1097/01.psy.0000181276.49204.bb
Rang HP, Bevan S, Dray A. Chemical activation of nociceptive peripheral neurones. Br Med Bull. 1991;47:534–48.
doi: 10.1093/oxfordjournals.bmb.a072491
Wand BM, O'Connell N, Parkitny L. 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. Man Ther. 2010;15:48–53 (Man Ther 2010;15:e1; author reply e2).
Wynne-Jones G, Jones GT, Wiles NJ, Silman AJ, Macfarlane GJ. Predicting new onset of widespread pain following a motor vehicle collision. J Rheumatol. 2006;33:968–74.
pubmed: 16541476
Hocking LJ, Smith BH, Jones GT, Reid DM, Strachan DP, Macfarlane GJ. Genetic variation in the beta2-adrenergic receptor but not catecholamine-O-methyltransferase predisposes to chronic pain: results from the 1958 British Birth Cohort Study. Pain. 2010;149:143–51.
doi: 10.1016/j.pain.2010.01.023
McLean SA. The potential contribution of stress systems to the transition to chronic whiplash-associated disorders. Spine (Phila Pa 1976). 2011;36:S226–S23232.
doi: 10.1097/BRS.0b013e3182387fb4
Gaab J, Baumann S, Budnoik A, Gmunder H, Hottinger N, Ehlert U. Reduced reactivity and enhanced negative feedback sensitivity of the hypothalamus-pituitary-adrenal axis in chronic whiplash-associated disorder. Pain. 2005;119:219–24.
doi: 10.1016/j.pain.2005.10.001
Shaked D, Shaked G, Sebbag G, Czeiger D. Can cortisol levels predict the severity of acute whiplash-associated disorders? Eur J Trauma Emerg Surg. 2018;12:1–6.
Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286:1841–8.
doi: 10.1001/jama.286.15.1841
Griep EN, Boersma JW, Lentjes EG, Prins AP, van der Korst JK, de Kloet ER. Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain. J Rheumatol. 1998;25:1374–81.
pubmed: 9676772
Kapur D. Whiplash and fibromyalgia. J Rheumatol. 2014;41:2323.
doi: 10.3899/jrheum.140556
Morilak DA, Barrera G, Echevarria DJ, Garcia AS, Hernandez A, Ma S, et al. Role of brain norepinephrine in the behavioral response to stress. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29:1214–24.
doi: 10.1016/j.pnpbp.2005.08.007
Rich EL, Romero LM. Exposure to chronic stress downregulates corticosterone responses to acute stressors. Am J Physiol Regul Integr Comp Physiol. 2005;288:R1628–R16361636.
doi: 10.1152/ajpregu.00484.2004
Bellon JM, Manzano L, Larrad A, Honduvilla GN, Bujan J, Alvarez-Mon M. Endocrine and immune response to injury after open and laparoscopic cholecystectomy. Int Surg. 1998;83:24–7.
pubmed: 9706511
Jeffries MK, Vance ML. Growth hormone and cortisol secretion in patients with burn injury. J Burn Care Rehabil. 1992;13:391–5.
doi: 10.1097/00004630-199207000-00001
Malik H, Lovell M. Soft tissue neck symptoms following high-energy road traffic accidents. Spine (Phila Pa 1976). 2004;29:E315–E317317.
doi: 10.1097/01.BRS.0000132514.33078.DA
Galasko CSB, Murray P, Stephenson W. Incidence of whiplash-associated disorder. BCM J. 2002;44:237–40.
Yadla S, Ratliff JK, Harrop JS. Whiplash: diagnosis, treatment, and associated injuries. Curr Rev Musculoskelet Med. 2008;1:65–8.
doi: 10.1007/s12178-007-9008-x
Hendriks EJ, Scholten-Peeters GG, van der Windt DA, Neeleman-van der Steen CW, Oostendorp RA, Verhagen AP. Prognostic factors for poor recovery in acute whiplash patients. Pain. 2005;114:408–16.
Holm LW, Carroll LJ, Cassidy JD, Hogg-Johnson S, Cote P, Guzman J, et al. The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. J Manipul Physiol Ther. 2009;32:S61–S6969.
doi: 10.1016/j.jmpt.2008.11.011
Richter M, Ferrari R, Otte D, Kuensebeck HW, Blauth M, Krettek C. Correlation of clinical findings, collision parameters, and psychological factors in the outcome of whiplash associated disorders. J Neurol Neurosurg Psychiatry. 2004;75:758–64.
doi: 10.1136/jnnp.2003.026963
Halbreich U, Olympia J, Carson S, Glogowski J, Yeh CM, Axelrod S, et al. Hypothalamo-pituitary-adrenal activity in endogenously depressed post-traumatic stress disorder patients. Psychoneuroendocrinology. 1989;14:365–70.
doi: 10.1016/0306-4530(89)90006-1
Yehuda R, Boisoneau D, Mason JW, Giller EL. Glucocorticoid receptor number and cortisol excretion in mood, anxiety, and psychotic disorders. Biol Psychiatry. 1993;34:18–25.
doi: 10.1016/0006-3223(93)90252-9
Yehuda R, Boisoneau D, Lowy MT, Giller EL Jr. Dose-response changes in plasma cortisol and lymphocyte glucocorticoid receptors following dexamethasone administration in combat veterans with and without posttraumatic stress disorder. Arch Gen Psychiatry. 1995;52:583–93.
doi: 10.1001/archpsyc.1995.03950190065010
Zohar J, Yahalom H, Kozlovsky N, Cwikel-Hamzany S, Matar MA, Kaplan Z, et al. High dose hydrocortisone immediately after trauma may alter the trajectory of PTSD: interplay between clinical and animal studies. Eur Neuropsychopharmacol. 2011;21:796–809.
doi: 10.1016/j.euroneuro.2011.06.001
Zohar J, Juven-Wetzler A, Sonnino R, Cwikel-Hamzany S, Balaban E, Cohen H. New insights into secondary prevention in post-traumatic stress disorder. Dialog Clin Neurosci. 2011;13:301–9.
doi: 10.31887/DCNS.2011.13.2/jzohar
Pettersson K, Toolanen G. High-dose methylprednisolone prevents extensive sick leave after whiplash injury. A prospective, randomized, double-blind study. Spine (Phila Pa 1976). 1998;23:984–9.