Electrical injury linked to complex pain & movement disorders later in lives of patients: study

Australia: E.W.Y. Lun, A.C. Tan, C.J. Andrews et al. et al retrospectively analyzed 15 cases from 2004 to 2019 of adult claimants assessed in a medico-legal practice for complex chronic pain disorders secondary to Electrical Injury (EI). Extensive biopsychosocial information, including 165 data items on pre- and post-injury observations, was 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.

• 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.

• The primary site of injury was the hand in all cases.

• Most (10/15) patients presented to an emergency department within a week, and 5 required to be admitted as a hospital inpatient.

• Secondary musculoskeletal and head injuries were common (14/15), and 6 claimants required surgery.

• Somatosensory signs in wide distribution in all cases implied central sensitization.

• Clinically significant sleep disturbance was reported in all but one case, prominent daytime fatigue in 8, major inactivity in 4, with at least 5 kg weight gain in 5.

• 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.

The authors concluded that - The extensive and long persistent clinical features attributed to EI had such a level of consistency between the 15 cases that the most highly shared features might be considered a syndromic aid to diagnosis. The key features included chronic pain, widespread especially in those with secondary musculoskeletal injury; impaired sleep and fatigue; post-traumatic stress, anxiety, depression, often major; somatosensory stimulus-response test responses implying central sensitization; movement disorders, particularly restless legs syndrome; and multiple seriously adverse social outcomes. Improved knowledge of this post-EI syndrome by the medical profession will assist in much needed improvement in the diagnosis, assessment and management. There is a need for early and continuing biopsychosocial assessment and for more education in pain medicine including somatosensory testing. 

Key Words: Electrical injury, Biopsychosocial, Post traumatic stress disorder (PTSD), Central sensitization, Movement disorders, Chronic pain, Medicolegal, Case series, Injury.

Further Reading:

Electrical injury: Chronic pain, somatosensory dysfunction, post traumatic stress and movement disorders

Elizabeth W Y Lun, Aidan C Tan, Christopher J Andrews, G. David Champion.

Injury 53 (2022) 1667–1677

https://doi.org/10.1016/j.injury.2022.02.038