Electrical injury: Chronic pain, somatosensory dysfunction, post traumatic stress and movement disorders

Elizabeth W Y Lun; Aidan C Tan; Christopher J Andrews; G David Champion

doi:10.1016/j.injury.2022.02.038

Electrical injury: Chronic pain, somatosensory dysfunction, post traumatic stress and movement disorders

Injury. 2022 May;53(5):1667-1677. doi: 10.1016/j.injury.2022.02.038. Epub 2022 Feb 17.

Authors

Elizabeth W Y Lun¹, Aidan C Tan², Christopher J Andrews³, G David Champion⁴

Affiliations

¹ University of New South Wales, St Vincent's Clinical School, St Vincent's Hospital, Level 5, deLacy Building, Victoria Street, Darlinghurst, NSW 2010, Australia. Electronic address: dr.elizabeth.lun@gmail.com.
² University of New South Wales, South Western Sydney Clinical School, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia; Western Sydney University, School of Medicine, 30 Narellan Road & Gilchrist Drive, Campbelltown NSW 2560, Australia. Electronic address: aidan.tan@unsw.edu.au.
³ Department of Primary Care, University of Queensland, Brisbane, QLD 4072, Australia. Electronic address: cjabar517@bigpond.com.
⁴ St Vincent`s Clinic, Rheumatology and Pain Medicine, 438 Victoria St, Darlinghurst, NSW 2010, Australia; University of New South Wales, School of Women's and Children's Health, Level 8, Bright Alliance, High Street, Randwick, NSW 2031, Australia. Electronic address: gdavidchampion@gmail.com.

PMID: 35287966
DOI: 10.1016/j.injury.2022.02.038

Abstract

Introduction and aims: We aimed in this case series to identify shortcomings in assessment of long-term painful and psychosocial consequences of EI and to demonstrate the value of biopsychosocial assessment and the commonalities in outcomes.

Methods: We retrospectively analyzed 15 cases from 2004 to 2019 of adult claimants assessed in a medico-legal practice for complex chronic pain disorders secondary to EI. Extensive biopsychosocial information, including 165 data items on pre- and post-injury observations, were collected on each. Cutaneous and deep pressure somatosensory examination was performed and questionnaires for psychological evaluation and restless legs syndrome completed. A comprehensive literature review and descriptive analysis was conducted.

Results: Pre-injury, most claimants worked (12/15), did not receive government benefits (14/15) and had no primary pain disorder (9/15). EIs were severe (14/15), where chronic post-traumatic pain, typically high impact with nociplastic features, was regional in 5 and widespread in 10. Somatosensory signs in wide distribution in all cases implied central sensitization. Movement disorders included digital dyskinesia (5/15), involuntary muscle contractions (7/15) and restless legs syndrome in 7. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) post-traumatic stress disorder (PTSD) criteria were met in 12/15, and 14/15 experienced depression and impaired sleep. Severe social impacts, notably including loss of employment resulting in financial stresses, were common.

Conclusions: Biological, psychological and social consequences of EI revealed extensive similarities. Disability was generally severe, moreso than indicated in clinical records, influenced by relative paucity of primary pathology, inadequate pain-orientated somatosensory testing and insufficient application of biopsychosocial assessment and management.

Keywords: Biopsychosocial; Case series; Central sensitization; Chronic pain; Electrical injury; Medicolegal; Movement disorders; Post traumatic stress disorder (PTSD).

MeSH terms

Adult
Chronic Pain* / etiology
Humans
Movement Disorders*
Restless Legs Syndrome*
Retrospective Studies
Stress Disorders, Post-Traumatic* / psychology