Presented at the 2013 AAPM Annual Meeting« Back

Previously Unrecognized Cognitive Dysfunction and/or Psychological Disorders in Patients with Chronic Neck Pain Due to Whiplash Injury

Wesley R. Prickett, MD, pioneer41@gmail.com¹, Kenneth A. Follett, MD PhD², Daniel M. Doleys, PhD³, Nicholas W. Markin, MD⁴, (1) UC Davis Medical Center, Sacramento, California, (Jerome Schofferman, MD, jschofferman@spinecare.com1, (1) SpineCare Medical Group, Daly City, California

Introduction: Pain specialists treat patients with chronic neck pain (NP) after motor vehicle collision (MVC) or other trauma. Some patients also have other symptoms including cognitive impairment (CI) and psychological illness. When such problems are not obvious, they might go unrecognized. Methods: While evaluating patients with chronic NP after MVC or other trauma, we performed a ROS that included direct questions about changes in memory, mood, swings in emotions and difficulties with simple calculations. All who answered positively for any of these symptoms had psychological interview, Rorschach, and neuropsychological tests (NPT) of intellectual functioning, attention and concentration, memory and learning, executive functioning, and emotional functioning. Study was approved by IRB. Results: There were 34 patients; 22 were injured in MVC, 6 in a fall, and 6 suffered other forms of injury. None had known direct head trauma. 13 (38%) had loss of consciousness. All patients had abnormal testing; 4 (12%) had CI only, 11 (32%) had psychological disorder only [depression (8), PTSD (2), adjustment disorder (1)], and 19 (56%) had both CI and psychological disorder. In no patient was psychological disorder deemed severe enough to cause cognitive impairment. It is noteworthy that patients had seen an average of 4 (2-7) physicians, and neither CI nor psychological disorder had been considered. Conclusions: When there were changes in affect, memory, or personality in patients with chronic NP after trauma, there was a high prevalence of cognitive impairment and/or and psychological disorders, neither of which had been diagnosed previously. References: 1) Kreitler S, Niv D. Cognitive impairment in chronic pain. Pain Clinical Updates 2007;15:1-4. 2) Iverson G, Brooks B, Langenecker S Young A. Identifying a cognitive impairment subgroup in adults with mood disorders. J Affect Disord 2011;132:360-7. 3) Crooks C, Zumsteg J, Bell K. Traumatic brain injury: a review. Phys Med Rehabil Clin N AM 2007;18:681-710. 4) Robinson J, Burwinkle T, Turk D. Perceived and actual memory, concentration and attention problems after whiplash-associated disorders (Grades I and II): Prevalence and predictors. Arch Phys Med Rehabil 2007;88:774-9. 5) Lange R, Iverson G, Rose A. Depression strongly influences postconcussion symptom reporting following mild traumatic brain injury. J Head Trauma Rehabil 2011;26:127-37. 6) Powell J, Ferraro J, Dikmen S et al. Accuracy of mild traumatic brain injury diagnosis. Arch Phys Med Rehabil 2008;89:1550-1555.

Funding: None