Session Title: AA 2021 Virtual Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Jeffrey S. Hecht, MD, FAAPMR: No financial relationships or conflicts of interest
Objective: To understand whether people with preexistent chronic pain still feel the pain when the brain is severed from the peripheral source of the pain due to complete spinal cord injury
Design: Prospective query regarding preexistent chronic pain of patients admitted with new complete cervical spinal cord injury (SCI) from 2018-2020. For those with prior pain, further questions were asked about current post traumatic pain. Billing records and the Trauma Center Data Base were used to identify the number of patients in the larger group.Setting : Level I Trauma CenterParticipants : Patients with acute cervical SCI with complete motor and sensory quadriplegia and who had a history of chronic pain
Main Outcome Measures: The primary outcome was chronic pain before the injury compared to that pain following the injury. The level and severity of SCI was based on International Standards for Neurological Classification of Spinal Cord Injury. Secondary measure was opioid use.
Results: Among 49 patients with complete cervical SCIs, seven had prior chronic pain. Four of these patients had continued pain after their complete quadriplegia. Three patients did not have continuation of the chronic pain—the patients who were not on chronic opioids.Conclusions: There is some chronic pain that is based in the brain irrespective of ongoing peripheral pain. This is different from the “centralized pain” caused by changes in the dorsal horn of the spinal cord and from “widespread pain syndrome”. Additionally, this provides a new model for evaluation of brain-based pain isolated from the sympathetic nervous system. Opioids may be requisite for this type of pain. This understanding, that some seemingly peripheral pain is centralized to the brain itself, may be of benefit to primary care physicians and interventionalists treating pain. For those treating SCI patients, some unexplained persistent pain may have been preexistent.
Level of Evidence: Level II
To cite this abstract in AMA style:Hecht JS. “Your Pain Is All in Your Head”: What Quadriplegics Teach Us About Chronic Pain [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/your-pain-is-all-in-your-head-what-quadriplegics-teach-us-about-chronic-pain/. Accessed January 25, 2022.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/your-pain-is-all-in-your-head-what-quadriplegics-teach-us-about-chronic-pain/