Pain and Cerebral Blood Flow in Children Shortly After Mild Traumatic Brain Injury Compared to Orthopedic Injury
Date
2022-09
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Abstract
Aims: The aims of the current study are to: (1) examine pain ratings in children following mild traumatic brain injury (mild TBI) compared to a control group of orthopedic injury (OI), (2) compare cerebral blood flow (CBF) approximately 10 days post-injury between the two injury groups, and (3) investigate the association between children’s pain ratings and CBF to determine whether the association may vary depending on the type of injury (mild TBI vs OI). Methods: This was a prospective study of children and adolescents ages 8-16 years following mild TBI (n = 374) or OI (n = 202) recruited from emergency departments across five sites in Canada (Calgary, Edmonton, Montreal, Ottawa, Vancouver). They were assessed at a post-acute follow-up approximately 7 days post-injury. They rated pain intensity (“Over the past week, how much hurt do you have?”) from 0 (no pain) to 10 (worst pain possible) and pain unpleasantness (“how much do aches or pains bother you?”) from 0 (not at all) to 4 (very much). CBF was measured using arterial spin labeling (ASL) with a pseudo-continuous (Calgary, Montreal GE, Vancouver) or pulsed approach (Edmonton, Montreal Siemens, Ottawa). Results: Children with mild TBI reported significantly higher pain intensity (M = 4.77, SD = 2.38 versus M = 4.01, SD = 2.26, η2 = 0.015) and unpleasantness (M = 1.78, SD = 1.02 versus M = 1.30, SD = 0.89, η2 = 0.029) compared to children with OI. Final CBF analyses were focused on data from Calgary and Vancouver, given quality concerns with data from other scanners. Absolute CBF, but not relative CBF, was significantly lower in the mild TBI than OI group (η2 ranged from 0.017 to 0.041) across all seven regions of interest (ROI) and global grey matter, after correcting for multiple comparisons. Relative CBF in four ROIs in the parietal lobe (intraparietal sulcus, inferior parietal lobe, primary somatosensory cortex, and superior parietal lobe) were significant predictors of children’s pain intensity ratings, but only in the OI group, and not the mild TBI group. Conclusions: Absolute CBF was decreased in the mild TBI compared to OI group. There was no clear association between children’s pain ratings and absolute or relative CBF after mild TBI. More research is needed to better understand the pathophysiology of vascular changes following mild TBI, and how these changes may be related to pain, post-concussive symptoms, and other aspects of functioning.
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Keywords
mild traumatic brain injury, pediatrics, arterial spin labeling, concussion, cerebral blood flow, pain, headache
Citation
Kwan, V. (2022). Pain and cerebral blood flow in children shortly after mild traumatic brain injury compared to orthopedic injury (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.