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Abstract
Objective To characterize the pain-related somatosensory and psychological presentation of very early acute patients with a mild traumatic brain injury (mTBI).
Methods Patients with an mTBI participated in a prospective observational study undergoing clinical, psychophysic, and psychological assessment within 72 hours after the accident. Healthy controls underwent similar protocol.
Results One hundred acute patients with an mTBI (age 36 ± 12.5 [SD] years, range 19–67 years, 42 women) and 80 healthy controls (age 43 ± 14.3 years, range 24–74 years, 40 women) participated. Patients with an mTBI demonstrated a pronociceptive psychophysic response in most tests such as less efficient pressure-pain threshold–conditioned pain modulation (0.19 ±0.19±.09 vs. 0.91±.10 kg, p < 0.001) and lower temperature needed to elicit a Pain50 response (44.72 ± 0.26°C vs 46.41 ± 0.30°C, p < 0.001). Their psychophysic findings correlated with clinical pain measures, e.g., Pain50 temperature and mean head (r = −0.21, p = 0.045) and neck (r = −0.26, p = 0.011) pain. The pain-catastrophizing magnification subscale was the only psychological variable to show a difference from the controls, while no significant correlations were found between any psychological measures and the clinical or psychophysic pain measures.
Conclusions There appears to be a dichotomy between somatosensory and psychological findings in the very early acute post-mTBI stage; while the first is altered and is associated with the clinical picture, the second is unchanged. In the context of the ongoing debate on the pathophysiologic nature of the post-mTBI syndrome, our findings support its “physical” basis, free of mental influence, at least in the short time window after the injury.
Glossary
- cWAD=
- chronic whiplash-associated disorder;
- mTBI=
- mild traumatic brain injury;
- NPS=
- Numerical Pain Scale;
- PSQ=
- Pain Sensitivity Questionnaire;
- TBI=
- traumatic brain injury;
- WAD=
- whiplash-associated disorder
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received December 20, 2017.
- Accepted in final form June 6, 2018.
- © 2018 American Academy of Neurology
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