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Kuperman P, Granovsky Y, Granot M, Bahouth H, Fadel S, Hyams G, Ben Lulu H, Aspis O, Salame R, Begal J, Hochstein D, Grunner S, Honigman L, Reshef M, Sprecher E, Bosak N, Sterling M, Yarnitsky D. Psychophysic-psychological dichotomy in very early acute mTBI pain: A prospective study. Neurology 2018; 91:e931-e938. [PMID: 30068635 DOI: 10.1212/wnl.0000000000006120] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/06/2018] [Indexed: 11/15/2022] Open
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.
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Affiliation(s)
- Pora Kuperman
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Yelena Granovsky
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Michal Granot
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Hany Bahouth
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Shiri Fadel
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Gila Hyams
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Hen Ben Lulu
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Osnat Aspis
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Rabia Salame
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Julia Begal
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - David Hochstein
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Shahar Grunner
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Liat Honigman
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Maya Reshef
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Elliot Sprecher
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Noam Bosak
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - Michele Sterling
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia
| | - David Yarnitsky
- From the Faculty of Medicine (P.K., Y.G., S.F., L.H., M.R.), Technion-Israel Institute of Technology; Department of Nursing (M.G.), Faculty of Welfare and Health Sciences, University of Haifa; TraumaEmergency Surgery (H.B., H.B.L.), Nursing (G.H.), ICU (O.A.), Department of Emergency Medicine (R.S.), General Surgery Department (J.B., D.H., S.G.), Department of Neurology (E.S., N.B., D.Y.), and Faculty of Medicine (D.Y.), Rambam Health Care Campus, Haifa, Israel; and RECOVER Injury Research Centre (M.S.), NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Brisbane, Australia.
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