***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Hypersensitivity to a variety of sensory stimuli is a feature of persistent whiplash associated disorders ( WAD ) . However , little is known about sensory disturbances from the time of injury until transition to either recovery or symptom persistence . Quantitative sensory testing  ( pressure and thermal pain thresholds , the brachial plexus provocation test ) , the  sympathetic vasoconstrictor reflex and psychological distress ( GHQ‐28 ) were prospect ively measured in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . Sensory and sympathetic nervous system tests were also measured in 20 control subjects . All whiplash groups demonstrated local mechanical hyperalgesia in the cervical spine at 1 month post‐injury . This hyperalgesia persisted in those with moderate/severe symptoms at 6 months but resolved by 2 months in those who had recovered or reported persistent mild symptoms . Only those with persistent moderate/severe symptoms at 6 months demonstrated generalised hypersensitivity to all sensory tests . These changes occurred within 1 month of injury and remained unchanged throughout the study period . Whilst no significant group differences were evident for the sympathetic vasoconstrictor response , the moderate/severe group showed a tendency for diminished sympathetic reactivity . GHQ‐28 scores of the moderate/severe group were higher than those of the other two groups . The differences in GHQ‐28 did not impact on any of the sensory measures . These findings suggest that those with persistent moderate/severe symptoms at 6 months display , soon after injury , generalised hypersensitivity suggestive of changes in central pain processing mechanisms . This phenomenon did not occur in those who recover or those with persistent mild symptoms Objective of the investigation : In a 6-month prospect i ve study of 141 consecutive acute whiplash-injured participants , and 40 acute , ankle-injured controls , pain and tenderness in the neck/head , and at a distant control site , were measured . Basic procedures : Muscle palpation and pressure algometry in five head/neck muscle-pairs were performed after 1 week and 1 , 3 and 6 months after injury . Algometry was performed at a distant control site . Main findings : Whiplash-injured patients had lowered pressure-pain-detection thresholds and higher palpation-score initially in the neck/head , but the groups were similar after 6 months , and the control site was not sensitized . Principal conclusion : Focal , but not generalized , sensitization to musculoskeletal structure is present until 3 months , but not 6 months , after whiplash injury , and probably does not play a major role in the development of late whiplash syndrome . Pressure algometry and palpation are useful clinical tools in the evaluation of neck and jaw pain in acute whiplash injury & NA ; Widespread sensory hypersensitivity is present in acute whiplash and is associated with poor recovery . Decreased nociceptive flexion reflex ( NFR ) thresholds ( spinal cord hyperexcitability ) are a feature of chronic whiplash but have not been investigated in the acute to chronic injury stage . This study compared the temporal development of sensory hypersensitivity and NFR responses from soon after injury to either recovery or to transition to chronicity . It also aim ed to identify predictors of persistent spinal cord hyperexcitability . Pressure and cold pain thresholds , NFR responses ( threshold and pain VAS )  were prospect ively measured in 62 participants at <3 weeks , 3 and 6 months post whiplash injury and in 22 healthy controls on two occasions a month apart . Pain levels and psychological distress ( GHQ‐28 ; IES ) were measured at baseline . Whiplash participants were classified at 6 months post‐injury using the Neck Disability Index : recovered ( ≤8 % ) , mild pain and disability ( 10–28 % ) or moderate/severe pain and disability ( ≥30 % ) . All whiplash groups  demonstrated spinal cord hyperexcitability ( lowered NFR thresholds ) at 3 weeks post‐injury . This hyperexcitability persisted in those with moderate/severe symptoms at 6 months but resolved in those who recovered or reported lesser symptoms at 6 months . In contrast generalized sensory hypersensitivity ( pressure and cold ) was only ever present in those with persistent moderate/severe symptoms and remained unchanged throughout the study period . This suggests different mechanisms underlie sensory hypersensitivity and NFR responses . In multivariate analyses only initial NDI scores ( p = 0.003 ) were a unique predictor of persistent spinal cord hyperexcitability indicating possible ongoing peripheral nociception following whiplash injury Objectives : To investigate sensory changes present in patients with chronic whiplash-associated disorders and chronic idiopathic neck pain using a variety of quantitative sensory tests to better underst and the pain processing mechanisms underlying persistent symptoms . Methods : A case control study was used with 29 subjects with chronic whiplash-associated disorders , 20 subjects with chronic idiopathic neck pain , and 20 pain-free volunteers .  Pressure pain thresholds  were measured over the articular pillars of C2-C3 , C5-C6 , the median , radial , and ulnar nerve trunks in the arm and over a remote site , the muscle belly of tibialis anterior . Heat pain thresholds , cold pain thresholds , and von Frey hair sensibility were measured over the cervical spine , tibialis anterior , and deltoid insertion . Anxiety was measured with the Short-Form of the Spielberger State Anxiety Inventory . Results : Pressure pain thresholds were decreased over cervical spine sites in both subject groups when compared with controls ( P < 0.05 ) . In the chronic whiplash-associated disorders group , pressure pain thresholds were also decreased over the tibialis anterior , median , and radial nerve trunks ( P < 0.001 ) . Heat pain thresholds were decreased and cold pain thresholds increased at all sites ( P < 0.03 ) . No differencesin heat pain thresholds or cold pain thresholds were evident in the idiopathic neck pain group at any site compared with the control group ( P > 0.27 ) . No abnormalities in von Frey hair sensibility were evident in either neck pain group ( P > 0.28 ) . Discussion : Both chronic whiplash-associated disorders and idiopathic neck pain groups were characterized by mechanical hyperalgesia over the cervical spine . Whiplash subjects showed additional widespread hypersensitivity to mechanical pressure and thermal stimuli , which was independent of state anxiety and may represent changes in central pain processing mechanisms . This may have implication s for future treatment approaches Objectives ( 1 ) To investigate the development of hypoesthesia from soon after the whiplash injury to 6 months postinjury and ( 2 ) to determine differences in detection thresholds between those with initial features of poor recovery and those without these signs . Methods Fifty-two participants with acute whiplash-associated disorders ( WAD ) ( < 1 mo ) were classified as either “ high-risk ” ( n=17 ; Neck Disability Index > 30 ; sensory hypersensitivity ) or “ low risk ” ( n=35 ; without these signs ) .  Detection thresholds to electrical , thermal , and vibration stimuli and psychological distress were prospect ively measured within 1 month of injury and then 3 and 6 months postinjury . Detection thresholds were also measured in the 38 controls . Results Both WAD groups showed hypoesthesia ( vibration , electrical , and cold ) at 1 month postinjury . Vibration and electrocutaneous hypoesthesia persisted to 3 and 6 months only in the high-risk WAD group . Heat detection thresholds were not different between the groups at 1 month postinjury but were elevated in the high-risk group at 3 and 6 months . Both WAD groups were distressed at 1 month but this decreased by 3 months in the low-risk group . The differences in the Impact of Event Scale did not impact on any of the sensory measures . Discussion Sensory hypoesthesia is a feature of acute WAD but persists only in those at higher risk of poor recovery . These findings suggest the involvement of the central inhibitory mechanisms that may be sustained by ongoing nociception UNLABELLED Whiplash injury and chronic whiplash syndrome represent major health problems in certain western communities , pain being the main symptom . Sensitization of the nociceptive system may play a role for non-recovery after whiplash injury . AIMS This study examined if tolerance to endure pain stimuli may predict outcome in whiplash injury . In a prospect i ve fashion , 141 acute whiplash patients exposed to rear-end car collision ( WAD grade 1 - 3 ) and 40 ankle-injured controls were followed and exposed to a cold pressor test , respectively , 1 week , 1 , 3 , 6 and 12 months after the injury . VAS score of pain and discomfort was obtained before , during and after immersion of the dominant h and into cold water for 2 min . The McGill Pain Question naire showed that ankle-injured controls had higher initial pain scores than the corresponding whiplash group , while whiplash-injured subjects had higher scores at 6 months ; pain scores being similar at other time points . No difference was found in cold pressor pain between recovered whiplash patients and ankle-injured subjects . Non-recovery was only encountered in whiplash injury . Eleven non-recovered whiplash patients ( defined as : h and icap after 1 year ) showed reduced time to peak pain from 1 week to 3 months ( P<0.001 ) , 6 months ( P<0.01 ) , but not 12 months after the injury . A larger pain area was seen in non-recovered vs. recovered whiplash-injured subjects during the entire observation period ( P<0.001 ) . Non-recovery after whiplash was associated with initially reduced cold pressor pain endurance and increased peak pain , suggesting that dysfunction of central pain modulating control systems plays a role in chronic pain after acute whiplash injury OBJECTIVE To describe the natural course of patients with acute neck pain presenting in general practice and to identify prognostic factors for recovery and sick leave . DESIGN We conducted a prospect i ve cohort study with a 1-year follow-up in general practice . Question naires were collected at baseline and after 6 , 12 , 26 , and 52 weeks . Days of sick leave were dichotomized into two groups : below and above 7 days of sick leave . Logistic regression was used to identify prognostic factors for recovery and sick leave . PATIENTS Consecutive patients with nonspecific neck pain lasting no longer than 6 weeks were invited to participate . RESULTS One hundred eighty-seven patients were included and 138 ( 74 % ) provided follow-up data . After 1 year , 76 % of the patients stated to be fully recovered or much improved , although 47 % reported to have ongoing neck pain . Almost half of the patients on sick leave at baseline returned to work within 7 days . Multivariate analysis showed that the highest association with recovery was the advice of the general practitioner ( GP ) " to wait and see " ( odds ratio [ OR ] 6.7 , 95 % confidence interval [ CI ] 1.6 - 31.8 ) . For sick leave , referral by the GP , for physical therapy or to a medical specialist , showed the highest association ( OR 2.8 , 95 % CI 1.0 - 8.4 ) . CONCLUSION Acute neck pain had a good prognosis for the majority of patients , but still a relatively high proportion of patients reported neck pain after 1-year follow-up . The advice given by the GP " to wait and see " was associated with recovery , and " referral " was associated with prolonged sick leave SUMMARY Objective : To determine the impact of the lidocaine patch 5 % on pain qualities associated with low-back pain ( LBP ) through use of the Neuropathic Pain Scale ( NPS ) . Patients and methods : Patients were enrolled in an open-label , non-r and omized , prospect i ve , 6-week study involving 8 clinical trial sites in the United States . Eligible patients had non-radicular LBP and reported moderate-to-severe pain on the NPS at study enrollment . Patients were stratified to 3 groups based on the duration of their LBP , defined as acute/sub-acute ( < 3 months ) , short-term chronic ( 3–12 months ) , or long-term chronic LBP ( > 12 months ) . The lidocaine patch 5 % was applied to the area of maximal pain , using no more than a total of 4 patches changed every 24 h. Effectiveness was measured by change from baseline to Week 2 and Week 6 in 4 composite measures of the NPS : NPS-10 , NPS-4 , NPS-8 , and NPS-non-allodynia . Safety was assessed by adverse events ( AEs ) , dermal assessment of application site(s ) , and skin sensory testing . Results : In the combined patient population ( n = 71 ) , 6 weeks of treatment with lidocaine patch 5 % significantly improved all 4 NPS composite measures at both Week 2 and Week 6 ( p < 0.001 ) . Separate analyses by subgroups revealed differential improvements in the 4 composite measures . Eleven patients ( 15.5 % ) experienced treatment-related AEs that were primarily mild-to-moderate and dermal in nature . Conclusions : In patients with moderate-to-severe LBP , 2 weeks and 6 weeks of treatment with the lidocaine patch 5 % significantly reduces the 
    Output:
    
We found that : ( 1 ) there is consistent evidence for thermal and widespread mechanical pain hypersensitivity in the acute stage of whiplash , ( 2 ) there is no evidence for pain hypersensitivity in the acute and subacute stage of idiopathic neck pain , although the body of evidence is small , and ( 3 ) hyperalgesia and spinal cord hyperexcitability have been detected in early stages of nonspecific low back pain , although evidence about widespread effects are conflicting .