Central pain processing and chronic pain: case study

Background and Purpose: Chronic pain has been linked to concussion and traumatic brain injury for years, but the healthcare world is still searching for effective treatments for the pathology. The purpose of this case study is to highlight a progression of interventions that was very effective for a patient that had been dealing with chronic pain for 3 years, but even more specifically a 23-year-old patient whose pain onset following a sports concussion and is otherwise completely healthy. Case Description: This patient had a significant decrease in quality of life and functionality due to the severity of her pain. Her primary concerns were getting back to work as she held a leadership role in her job. She presented with severe pain with all shoulder movements, though no limits in ROM and very minor strength deficits. Central pain processing interventions such as motor imagery, action observation, and mirror therapy was the primary focus of her treatments. Outcomes: The patient had exceptional outcomes in response to central pain processing interventions. She presented with shoulder pain at initial eval that was so severe that it prevented her from performing her job well and driving normally, and was completely pain free at discharge. Her other post-concussive symptoms such as dizziness and lightheadedness improved significantly as well. Discussion: The biggest lesson to be learned from this case study is that in order to effectively treat pain, especially when chronic, one must consider the patient as a whole and utilize a top-down approach that addresses the way the brain is processing pain as well.