title: A comprehensive, multispecialty approach to an acute exacerbation of chronic central pain in a tetraplegic.
abstract: METHODS
  We present a case report describing the multidisciplinary treatment of a tetraplegic spinal cord injury (SCI) patient who developed an acute exacerbation of chronic central pain.
  
  
  OBJECTIVE
  To bring further awareness to the importance of using a comprehensive, multidisciplinary approach in treating acute exacerbation of chronic central pain in SCI patients.
  
  
  METHODS
  University of California Irvine Medical Center, Orange, CA, USA.
  
  
  METHODS
  We present a 34-year-old man with a past medical history of C5 American Spinal Injury Association B tetraplegia secondary to a surfing accident 8 years prior, central pain syndrome, spasticity, autonomic dysreflexia and anxiety who arrived at the emergency room with a 1-month history of worsening acute on chronic pain refractory to opioid escalation. The multispecialty treatment plan included treatment of the patient's urinary tract infection by the primary medicine service, management of the patient's depression by the psychiatric service, treatment of bowel obstruction by general surgery and adjustment of pain medications by pain management. The patient was found to have stable neurological findings, neuroimaging unchanged from prior imaging and a urinary tract infection. Hospitalization was complicated by severe colonic dilation that required disimpaction by general surgery.
  
  
  CONCLUSIONS
  The treatment of this patient's acutely worsened central pain highlights the importance of applying a multidisciplinary approach to SCI patients with an acute exacerbation of chronic central pain. In this case, the multispecialty treatment plan included treatment of the patient's urinary tract infection by the primary medicine service, management of the patient's depression by the psychiatric service, treatment of bowel obstruction by general surgery, and adjustment of pain medications by pain management.
authors: 1] Division of Pain Medicine, Department of Anesthesiology & Perioperative Care, The Center for Pain Medicine, Irvine, CA, USA [2] Department of Physical Medicine & Rehabilitation, University of California Irvine Medical Center, Orange, CA, USA [3] Department of Anesthesiology & Perioperative Care, University of California Irvine Medical Center, Orange, CA, USA.
authors: E Y
authors: EY
authors: Chang
authors: Department of Physical Medicine & Rehabilitation, University of California Irvine Medical Center, Orange, CA, USA.
authors: X
authors: X
authors: Zhao
authors: 1] Division of Pain Medicine, Department of Anesthesiology & Perioperative Care, The Center for Pain Medicine, Irvine, CA, USA [2] Department of Physical Medicine & Rehabilitation, University of California Irvine Medical Center, Orange, CA, USA [3] Department of Anesthesiology & Perioperative Care, University of California Irvine Medical Center, Orange, CA, USA.
authors: D M
authors: DM
authors: Perret
authors: Department of Anesthesiology & Perioperative Care, University of California Irvine Medical Center, Orange, CA, USA.
authors: Z D
authors: ZD
authors: Luo
authors: Department of Palliative Medicine, University of California Irvine Medical Center, Irvine, CA, USA.
authors: S S
authors: SS
authors: Liao
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology; D020211:Autonomic Dysreflexia / Q000209:etiology; D002490:Central Nervous System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology*; D059408:Pain Management; D011782:Quadriplegia / Q000150:complications*