Complex regional pain syndrome (type I) after electrical injury: a case report of treatment with continuous epidural block

Pain Influences Neuropsychological Performance Following Electrical Injury: A Cross-Sectional Study

OBJECTIVE

Electrical injury (EI) is a significant, multifaceted trauma often with multi-domain cognitive sequelae, even when the expected current path does not pass through the brain. Chronic pain (CP) research suggests pain may affect cognition directly and indirectly by influencing emotional distress which then impacts cognitive functioning. As chronic pain may be critical to understanding EI-related cognitive difficulties, the aims of the current study were: examine the direct and indirect effects of pain on cognition following EI and compare the relationship between pain and cognition in EI and CP populations.

METHOD

This cross-sectional study used data from a clinical sample of 50 patients with EI (84.0% male; M_age = 43.7 years) administered standardized measures of pain (Pain Patient Profile), depression, and neurocognitive functioning. A CP comparison sample of 93 patients was also included.

RESULTS

Higher pain levels were associated with poorer attention/processing speed and executive functioning performance among patients with EI. Depression was significantly correlated with pain and mediated the relationship between pain and attention/processing speed in patients with EI. When comparing the patients with EI and CP, the relationship between pain and cognition was similar for both clinical groups.

CONCLUSIONS

Findings indicate that pain impacts mood and cognition in patients with EI, and the influence of pain and its effect on cognition should be considered in the assessment and treatment of patients who have experienced an electrical injury.

Neurological and neuropsychological consequences of electrical and lightning shock: review and theories of causation

Injuries from lightning and electrical injuries involve multiple systems of the body, however neurological symptoms are very widely reported. A disabling neuropsychological syndrome is also noted. This paper presents a comprehensive review of neurological and neuropsychological symptoms. Partial theories of causation for these injuries have been advanced, however, there is no convincing explanation for both delay in onset of symptoms and also the genesis of the neuropsychological syndrome. A theory of causation is proposed which satisfies both these constraints. This theory suggests circulating hormones such as cortisol, together with nitric oxide and oxidant free radicals from glutamatergic hyper-stimulation, act on tissues remote from the injury path including the hippocampus. This theory opens a research path to explore treatment options.

Failure to fire after an electrical injury - a complex syndrome in a soldier

Complex regional pain syndrome (CRPS) is a disorder characterized by an intractable, disabling pain of the affected limb. It is triggered by various injuries and is often resistant to standard therapy. We report a young soldier with CRPS of the right hand sustained from an electrical injury, who had improvement in resting pain with Zoledronic acid. In this report, we discuss the therapeutic options and the role of bisphosphonates in CRPS.

Successful use of gabapentin in acute pain management following burn injury: a case series

Pain after burn injury has multiple qualities, including neuropathic and hyperalgesic elements. This element of the burn patients' pain experience is frequently difficult to manage and contributes significantly to their suffering. The onset may be either immediate or delayed. Gabapentin has established efficacy in the reduction of burn-induced hyperalgesia and allodynia in animal and human experimental burn models. This article reports a case series of six patients who, following admission to hospital with burn injury, described burning dysesthesia at either the injury or graft donor site. These patients were prescribed gabapentin in addition to standard analgesia. The use of gabapentin resulted in a rapid reduction in the severity of the neuropathic element of the pain. The medication was well tolerated, with no severe adverse reactions. Conclusions. This case series introduces the use of gabapentin as a potentially important therapy in the management of neuropathic pain following burn injury. Further research is required to define the use of gabapentin in this specific setting.

Neuropsychological changes following electrical injury

The clinical presentation of electrical injury commonly involves physical, cognitive, and emotional complaints. Neuropsychological studies, including case reports, have indicated that electrical injury (EI) survivors may experience a broad range of impaired neuropsychological functions, although this has not been clarified through controlled investigation. In this study, we describe the neuropsychological test findings in a series of 29 EI patients carefully screened and matched to a group of 29 demographically similar healthy electricians. Participants were matched by their estimated premorbid intellectual ability. Multivariate analysis of variance was used to assess group differences in the following neuropsychological domains: attention and mental speed, working memory, verbal memory, visual memory, and motor skills. EI patients performed significantly worse on composite measures of attention/mental speed and motor skills, which could not be explained by demographic differences, injury parameters, litigation status, or mood disturbance. Results suggest that cognitive changes do occur in patients suffering from electrical injury.