Research Reports - The influence of pain on cerebral functioning after mild traumatic brain injury

J Neurotrauma. 2012 Nov 20;29(17):2625-34

Gosselin N, Chen JK, Bottari C, Petrides M, Jubault T, Tinawi S, de Guise E, Ptito A

Abstract More than 75% of patients with mild traumatic brain injury (MTBI) report
chronic pain whose potential detrimental effects on cognitive recovery need to be
identified. The objective of this study was to investigate the relationship
between pain, performance on a working memory task, gray matter density, and
mid-dorsolateral prefrontal cortex (mid-DLPFC) activation in subjects with a
MTBI. For comparison purposes, we performed identical correlation analyses with a
group of subjects without MTBI who sustained sports injuries. Twenty-four
subjects who experienced a MTBI in the past 12 months, 16 control subjects, and
29 subjects with sport injuries were included. One hour prior to entering the
magnetic resonance scanner, the subjects were asked to fill out the pain Visual
Analogue Scale. Subsequently, a high-resolution T1-weighted image was acquired
followed by a functional magnetic resonance imaging session using the visual
externally ordered working memory task. Results showed that MTBI subjects
reporting severe pain in the hour preceding the testing had reduced mid-DLPFC
activation during the working memory task and poorer performance on the task.
Subjects with sport injuries and severe levels of pain showed the reverse
pattern: pain was associated with higher activation in the mid-DLPFC and did not
correlate with performance. Gray matter density measures were independent of pain
level. This study showed that behavioral performance and cerebral functioning are
affected by pain after a MTBI. Moreover, this study suggests that pain,
cognition, and cerebral functioning interactions could not easily be generalized
from one clinical population to another.

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