Preexistent Chronic Low Back Pain Can Persist After Spinal Cord Injury with Complete Quadriplegia-Central Pain, Brain

Research Objectives: To determine whether chronic low back pain persists after complete Spinal Cord Injury (SCI)

Design: Prospective observational study regarding preexistent chronic pain of inpatients admitted with new complete cervical SCI from 2018-2020. For patients acknowledging prior chronic pain, further questions explored the nature of that pain. Follow up was limited to the acute hospital stay.

Setting: Level I Trauma Center

Participants: From a total of 49 participants with acute traumatic cervical SCI causing complete motor and sensory quadriplegia, six men were selected because of their history of chronic low back.

Interventions: Detailed pain history and neurological examination as part of Physical Medicine & Rehabilitation (PM&R) consultation in the Trauma Center. Serial history and follow up examinations during the hospital stay.

Main Outcome Measures: Primary- chronic pain before complete SCI compared to continuation of that pain following the injury.
Secondary measure- opioid use.

Results: Among 49 patients with complete cervical SCIs, six had experienced prior chronic pain.
Three participants experienced a continuation of the prior pain after their complete quadriplegia (50%).

All the participants with continued pain had been previously treated with opioids, while those whose pain ceased (50%) had not received chronic opioid therapy.

Conclusions: Chronic pain can be based in the brain, irrespective of peripheral pain or spinal cord mechanisms.
Our findings provide a new model for evaluation of brain-based pain that is isolated from the sympathetic nervous system. Opioids may be requisite for this type of pain.

Author(s) Disclosures: The authors have no disclosures.