What is it about?

We aimed in this case series to identify shortcomings in assessment of long-term painful and psychosocial consequences of EI and to demonstrate the value of biopsychosocial assessment and the commonalities in outcomes. We retrospectively analyzed 15 cases from 2004 to 2019 of adult claimants assessed in a medico-legal practice for complex chronic pain disorders secondary to EI. Extensive biopsychosocial information, including 165 data items on pre- and post-injury observations, were collected on each. Cutaneous and deep pressure somatosensory examination was performed and questionnaires for psychological evaluation and restless legs syndrome completed. A comprehensive literature review and descriptive analysis was conducted.

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Why is it important?

Pre-injury, most claimants worked (12/15), did not receive government benefits (14/15) and had no primary pain disorder (9/15). EIs were severe (14/15), where chronic post-traumatic pain, typically high impact with nociplastic features, was regional in 5 and widespread in 10. Somatosensory signs in wide distribution in all cases implied central sensitization. Movement disorders included digital dyskinesia (5/15), involuntary muscle contractions (7/15) and restless legs syndrome in 7. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) post-traumatic stress disorder (PTSD) criteria were met in 12/15, and 14/15 experienced depression and impaired sleep. Severe social impacts, notably including loss of employment resulting in financial stresses, were common.Biological, psychological and social consequences of EI revealed extensive similarities. Disability was generally severe, moreso than indicated in clinical records, influenced by relative paucity of primary pathology, inadequate pain-orientated somatosensory testing and insufficient application of biopsychosocial assessment and management.

Perspectives

Long-term consequences of electrical injury were multidimensional, requiring comprehensive biopsychosocial assessment and management. All claimants had widely distributed chronic pain, features indicating nociplastic pain, and pain-related disability. Common features included post-traumatic stress disorder, movement disorders, multiple and concerning social consequences. Disability was frequently underestimated, influenced by unfamiliarity with the emerging concept of nociplastic pain.

Dr Aidan C Tan
University of Sydney

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This page is a summary of: Electrical injury: chronic pain, somatosensory dysfunction, Post traumatic stress and movement disorders, Injury, February 2022, Elsevier, DOI: 10.1016/j.injury.2022.02.038.
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