Pain and Quality of Life Following Nerve Injury
Abstract & Commentary
By Michael Rubin, MD, Professor of Clinical Neurology, Weill Cornell Medical College. Dr. Rubin reports no financial relationships relevant to this field of study.
Synopsis: The development of neuropathic pain after traumatic nerve injury is strongly influenced by premorbid personality traits that are dominated by "negative emotional states."
Source: Ciaramitaro P, et al. Traumatic peripheral nerve injuries: Epidemiological findings, neuropathic pain, and quality of life in 158 patients. J Peripheral Nervous System 2010;15:120-127.
Peripheral nerve injury often is followed by neuropathic pain and impaired quality of life. To assess the severity and prevalence of such pain, and the effects on quality of life, information was gathered on all patients with traumatic neuropathy referred to four Italian centers between July 1, 2007 and June 30, 2008. Diagnosis was confirmed by electrodiagnostic studies performed between 3 weeks to 6 months following trauma. Data collected included clinical, electrophysiological, and surgical history related to the injury, with Seddon's scale used to assess severity of injury, the DN4 questionnaire used to assess neuropathic pain,1 and a visual analog scale used to evaluate pain severity. Quality of life was assessed using the Beck Depression Inventory and Short Form-36 Health Survey, with disability measured by the modified Rankin scale and Overall Neuropathy Limitations score. Statistical analysis encompassed Student's t-test and the Wilcoxon test, with P < 0.05 considered statistically significant.
Among 158 consecutive patients, including 118 men and 40 women with a median age of 37 years, 211 traumatic nerve injuries were documented. Initial assessment occurred at a mean time of 99 days following trauma. Injury resulted from a variety of etiologies including stretch (53%), compression (45%), transection (22%), and ischemia (13%). Almost 50% of the injuries were due to motor vehicle accidents, with most lesions, more than 80%, involving the arm. Trauma most commonly involved the brachial plexus (36%), and iatrogenic injury (15% of total) usually affected the radial, ulnar, or peroneal nerve. Pain was present in 66% (104/158 patients), and was deemed neuropathic in 74% of these (50% of the total), based on the DN4 questionnaire. Most neuropathic pain (79%) was moderate to severe in intensity, and mean disability was moderate in degree. Beck Depression Inventory scores were significantly higher in those with pain than without, and the presence of neuropathic pain, but not age or gender, correlated with impaired quality of life.
Commentary
Not surprisingly, psychological factors play a role in the development of chronic pain following peripheral nerve injury.2 Among 31 patients who sustained a median and/or ulnar nerve transection, those who developed chronic neuropathic pain (n = 10) scored higher on scales measuring neuroticism and pain-catastrophizing. Neuroticism is defined as a tendency to "experience negative emotional states," to respond "poorly to environmental stress," to "interpret ordinary situations as threatening," and to focus more on "bodily sensations, with low pain thresholds and pain tolerance." Pain-catastrophizing is defined as an "exaggerated negative orientation towards pain," which correlates with "increased pain intensity and disability in chronic pain populations, is linked to fear of movement and avoidance, and may lead to disuse, increased disability, and depression." Compared to patients with no post-traumatic pain, chronic neuropathic pain patients demonstrated worse performance on motor dexterity, more abnormalities on nerve conduction studies in the form of prolonged distal latencies and smaller amplitudes, higher vibration detection thresholds, poorer performance on sensory-motor integration tasks, and reduced pain tolerance with increased pain intensity on the cold pressor test. Pre-morbid personality traits predict poor recovery following nerve injury.
References
1. Bouhassira D, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005;114:29-36.
2. Taylor KS, et al. Chronic pain and sensorimotor deficits following peripheral nerve injury. doi:10.1016/j.pain.2010.06.032.
The development of neuropathic pain after traumatic nerve injury is strongly influenced by premorbid personality traits that are dominated by "negative emotional states."You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content