Though we expect pain and discomfort following any serious physical injury, sometimes pain continues after the physical injury heals. This continuation of pain is called post-traumatic pain, which is typically the result of nerve damage.
Any severe injury to the body is called “physical trauma.” It is not uncommon for a patient to experience persistent, severe pain without an apparent cause after the initial injury has healed. Post-traumatic pain is any pain that occurs after the healing of injuries from physical trauma.
There are two main types of physical trauma:
Blunt force trauma, which is when an object or force strikes the body with enough force to cause a concussion, deep cut, or break a bone.
Penetrating trauma, which is when an object pierces the skin and creates an open wound.
Some common types of traumatic injuries include traumatic brain injury, spinal cord injury, spinal fractures, traumatic amputation, facial trauma, acoustic trauma, crush injury, concussion, and broken bones.
What Causes Post-Traumatic Pain?
Post-traumatic pain after a traumatic injury is common. In many cases, the chronic pain is the result of nerve damage (causalgia or mimocausalgia) caused by the trauma. Nerve damage is often the reason for a persistent pain even after the recovery from the physical trauma is complete.
No trauma is too small to cause post-traumatic pain. Even a sprain can result in post-traumatic pain. In fact, the nerve does not necessarily have to be damaged to cause pain. Sometimes, pressure on a nerve as a result of the injury is sufficient to cause pain that can range from mild to severe discomfort.
Doctors do not fully understand why some injuries trigger chronic pain; however, it’s believed that it may be a faulty communication between the central and peripheral nervous systems, as well as an inappropriate inflammatory response.
For example, arthritis, the inflammation of a joint, can be the cause of post-traumatic pain (called post-traumatic arthritis). Post-traumatic arthritis (the wearing out of the cartilage in a joint) is a common form of osteoarthritis that can occur after any kind of physical injury to a joint.
What are the Symptoms of Post-Traumatic Pain?
Following a traumatic injury, some discomfort is expected. The pain can be mild to severe. Over time, the pain symptoms can change and will vary from patient to patient.
Most commonly, pain, swelling, redness, noticeable changes in skin temperature, and hypersensitivity (particularly to cold and touch) are the initial symptoms of post-traumatic pain. Patients often describe post-traumatic pain as “burning,” “an unpleasant tingling,” or “numbness,” which are symptoms that resemble other nerve pain conditions like shingles.
Some of the more common symptoms of post-traumatic pain include:
Continuous burning or throbbing pain, usually in an arm, hand, leg, or foot.
Changes in skin temperature. The skin may appear sweaty and then become cold.
Changes in skin color. The skin can appear white and mottled to red or blue.
Changes in skin texture. The skin may become tender and sensitive to touch. It can be thin or shiny in the affected area.
Changes in hair and nail growth.
Decreased ability to move the affected body part.
Joint stiffness, swelling, and damage.
Muscle spasms, weakness, and loss (atrophy).
Sensitivity to touch or cold. The area may be hyper-sensitive to touch or cold temperatures.
Swelling of the painful area.
The pain can be worsened by emotional stress.
For some patients, the symptoms go away on their own. In others, chronic pain and dysfunction can persist for months or years.
If not diagnosed and treated early, post-traumatic pain may progress to increasingly disabling symptoms, which can include:
Atrophy (tissue wasting). Patients tend to avoid moving an arm or a leg because it hurts, or it is difficult to move because of stiffness. If the body part is not moved, skin, bones, and muscles may start to weaken and deteriorate.
Contracture (muscle tightening). The patient may experience a tightening of their muscles. This can potentially lead to a condition in which the hand and fingers, or foot and toes, contract into a fixed position.
How is Post-Traumatic Pain Diagnosed?
The nervous system consists of millions of nerves throughout the human body. Post-traumatic pain can be the result of any one of these nerves being affected by various types of trauma.
The diagnosis of chronic post-traumatic pain is based primarily on a physical exam and the patient’s medical history. Unfortunately, no one test will definitively diagnose post-traumatic pain, but there are diagnostic procedures that can provide important clues, such as:
Peripheral nerve blocks. This procedure attempts to block the suspected cause and trigger of the chronic pain to determine which nerve may need to be addressed to resolve the symptoms.
Bone scan. A test to detect bone changes. A radioactive substance is injected into a vein to aid in the view of bones with a special camera.
Sympathetic nervous system tests. These tests look for disturbances in the sympathetic nervous system (skin temperature, blood flow) in affected and unaffected limbs.
X-rays. The loss of minerals from the bones may show up on an X-ray in later stages of the disease.
Magnetic resonance imaging (MRI). Images from an MRI may show tissue changes.
Other tests can be used to measure the amount of sweat produced by both limbs. Dissimilar results are a potential indication of post-traumatic pain. A blood test, the erythrocyte sedimentation rate (ESR), can be performed to rule out diseases with similar symptoms arising from other causes.
How is Post-Traumatic Pain Treated?
Treatment for post-traumatic pain is most effective when started early in the course of the illness. Some of the medications and therapies for treating post-traumatic pain include:
Pain relievers. Over-the-counter (OTC) pain relievers—such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)—may ease pain and inflammation.
Antidepressants and anticonvulsants. These medications can be used to treat chronic pain originating from a damaged nerve.
Corticosteroids. Steroid medications, such as prednisone, may help reduce inflammation and improve mobility in an affected limb.
Sympathetic nerve-blocking medication. Injecting an anesthetic to block pain signals of affected nerves is helpful for some patients.
Physical therapy. Gentle, guided exercising of affected limbs can help decrease pain and improve strength and range of motion. Exercises tend to be more effective when the disease is diagnosed early.
Spinal cord stimulation. A small electrical current delivered to the spinal cord via tiny electrodes along the spinal cord can often help relieve chronic post-traumatic pain.
Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings via electrodes placed on the skin near the pain source.
The specific procedure and treatment for post-traumatic pain will depend on each patient and their unique situation.
Recurrences of post-traumatic pain can occur. It can be triggered by additional trauma, exposure to cold, or an intense emotional stressor. In some cases, recurrences can be managed with small doses of an antidepressant or other medication.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating post-traumatic pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.