E Y Chang1, X Zhao2, D M Perret1, Z D Luo3, S S Liao4. 1. 1] Division of Pain Medicine, Department of Anesthesiology & Perioperative Care, The Center for Pain Medicine, Irvine, CA, USA [2] Department of Physical Medicine & Rehabilitation, University of California Irvine Medical Center, Orange, CA, USA [3] Department of Anesthesiology & Perioperative Care, University of California Irvine Medical Center, Orange, CA, USA. 2. Department of Physical Medicine & Rehabilitation, University of California Irvine Medical Center, Orange, CA, USA. 3. Department of Anesthesiology & Perioperative Care, University of California Irvine Medical Center, Orange, CA, USA. 4. Department of Palliative Medicine, University of California Irvine Medical Center, Irvine, CA, USA.
Abstract
STUDY DESIGN: We present a case report describing the multidisciplinary treatment of a tetraplegic spinal cord injury (SCI) patient who developed an acute exacerbation of chronic central pain. OBJECTIVE: To bring further awareness to the importance of using a comprehensive, multidisciplinary approach in treating acute exacerbation of chronic central pain in SCI patients. SETTING: University of California Irvine Medical Center, Orange, CA, USA. CASE REPORT: We present a 34-year-old man with a past medical history of C5 American Spinal Injury Association B tetraplegia secondary to a surfing accident 8 years prior, central pain syndrome, spasticity, autonomic dysreflexia and anxiety who arrived at the emergency room with a 1-month history of worsening acute on chronic pain refractory to opioid escalation. The multispecialty treatment plan included treatment of the patient's urinary tract infection by the primary medicine service, management of the patient's depression by the psychiatric service, treatment of bowel obstruction by general surgery and adjustment of pain medications by pain management. The patient was found to have stable neurological findings, neuroimaging unchanged from prior imaging and a urinary tract infection. Hospitalization was complicated by severe colonic dilation that required disimpaction by general surgery. CONCLUSION: The treatment of this patient's acutely worsened central pain highlights the importance of applying a multidisciplinary approach to SCI patients with an acute exacerbation of chronic central pain. In this case, the multispecialty treatment plan included treatment of the patient's urinary tract infection by the primary medicine service, management of the patient's depression by the psychiatric service, treatment of bowel obstruction by general surgery, and adjustment of pain medications by pain management.
STUDY DESIGN: We present a case report describing the multidisciplinary treatment of a tetraplegic spinal cord injury (SCI) patient who developed an acute exacerbation of chronic central pain. OBJECTIVE: To bring further awareness to the importance of using a comprehensive, multidisciplinary approach in treating acute exacerbation of chronic central pain in SCI patients. SETTING: University of California Irvine Medical Center, Orange, CA, USA. CASE REPORT: We present a 34-year-old man with a past medical history of C5 American Spinal Injury Association B tetraplegia secondary to a surfing accident 8 years prior, central pain syndrome, spasticity, autonomic dysreflexia and anxiety who arrived at the emergency room with a 1-month history of worsening acute on chronic pain refractory to opioid escalation. The multispecialty treatment plan included treatment of the patient's urinary tract infection by the primary medicine service, management of the patient's depression by the psychiatric service, treatment of bowel obstruction by general surgery and adjustment of pain medications by pain management. The patient was found to have stable neurological findings, neuroimaging unchanged from prior imaging and a urinary tract infection. Hospitalization was complicated by severe colonic dilation that required disimpaction by general surgery. CONCLUSION: The treatment of this patient's acutely worsened central pain highlights the importance of applying a multidisciplinary approach to SCI patients with an acute exacerbation of chronic central pain. In this case, the multispecialty treatment plan included treatment of the patient's urinary tract infection by the primary medicine service, management of the patient's depression by the psychiatric service, treatment of bowel obstruction by general surgery, and adjustment of pain medications by pain management.
Authors: Robert W Teasell; Swati Mehta; Jo-Anne L Aubut; Brianne Foulon; Dalton L Wolfe; Jane T C Hsieh; Andrea F Townson; Christine Short Journal: Arch Phys Med Rehabil Date: 2010-05 Impact factor: 3.966
Authors: Gianluca Castelnuovo; Emanuele M Giusti; Gian Mauro Manzoni; Donatella Saviola; Arianna Gatti; Samantha Gabrielli; Marco Lacerenza; Giada Pietrabissa; Roberto Cattivelli; Chiara A M Spatola; Stefania Corti; Margherita Novelli; Valentina Villa; Andrea Cottini; Carlo Lai; Francesco Pagnini; Lorys Castelli; Mario Tavola; Riccardo Torta; Marco Arreghini; Loredana Zanini; Amelia Brunani; Paolo Capodaglio; Guido E D'Aniello; Federica Scarpina; Andrea Brioschi; Lorenzo Priano; Alessandro Mauro; Giuseppe Riva; Claudia Repetto; Camillo Regalia; Enrico Molinari; Paolo Notaro; Stefano Paolucci; Giorgio Sandrini; Susan G Simpson; Brenda Wiederhold; Stefano Tamburin Journal: Front Psychol Date: 2016-02-19