Widespread Pain in Persistent Post-Concussive Syndrome: Considerations for Surgical Candidacy

Introduction: Chronic pain is a significant and often debilitating consequence for approximately two-thirds of individuals with mild traumatic brain injury (mTBI), frequently leading to long-term disability. Identifying pain mechanisms, especially central sensitization, in patients with persistent post-concussive syndrome is essential for surgical decision-making. Misinterpreting central sensitization as chronic post traumatic pain localized to discrete body parts can result in ineffective or counterproductive surgical interventions. Therefore, assessing chronic pain mechanisms is critical to determine appropriate surgical candidacy, potentially improving outcomes and reducing postoperative complications.

Methods: A retrospective observational study on mTBI patients with chronic pain was conducted following the STROBE guidelines. Included were patients with persistent post-concussive syndrome post-mTBI. Exclusions included prior chronic pain, less than 90 days post-injury, or neurological comorbidities. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) measured symptom severity, and central sensitization was assessed via the Widespread Pain Index and Symptom Severity Index. A simple linear regression analysis was used to investigate the influence of age on WPI and RPQ scores. Correlations between post-concussion symptom severity and widespread pain were analyzed. The diagnosis of PPCS was supported by videonystagmography and neurophysiological methods.

Results: Of 223 mTBI patients, 67 met criteria. Exclusions were mainly for pre-existing chronic pain or other neurological diagnoses. Central sensitization strongly correlated with severe non-painful symptoms, indicated shared central nervous system mechanisms

Conclusion : Central sensitization appears to be a primary pain mechanism in chronic mTBI cases. Recognition of centralized pain can help surgeons make informed decisions about surgical candidacy, potential avoiding unnecessary surgeries and enhancing treatment efficacy.