Chronic Pain: Neurological Issues After a Concussion - Neurology

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Chronic pain following a concussion can be a complex issue, often involving a combination of neurological, musculoskeletal, and psychological factors. Given your history of a concussion, along with the symptoms you are experiencing—such as persistent headaches, shoulder and arm pain, numbness in your fingers, and discomfort in your lower back—it is essential to approach your situation holistically.

Firstly, it's important to understand that a concussion can lead to various neurological issues. Even if initial imaging, like X-rays, showed no significant damage, the brain can still be affected in ways that are not immediately visible. Symptoms such as chronic headaches, cognitive difficulties, and emotional disturbances can arise from post-concussion syndrome (PCS), which can persist for weeks, months, or even longer after the injury. The headaches you are experiencing could be tension-type headaches or migraines, both of which are common after a concussion.

Moreover, the pain in your shoulders and arms, along with the numbness in your fingers, raises the possibility of cervical spine involvement. The cervical spine is the portion of the spine that runs through the neck, and injuries or misalignments in this area can lead to nerve compression. This compression can cause symptoms like pain, tingling, or numbness in the arms and hands, as well as headaches that may radiate from the neck. The fact that you feel pain when pressing on a specific cervical vertebra suggests that there may be an underlying issue, such as a herniated disc or cervical spondylosis, which could be contributing to your symptoms.

Additionally, the sensation of choking on saliva during sleep and the pain radiating to your lower back and legs could indicate a more systemic issue, potentially involving the nervous system or muscular-skeletal system. Sleep disturbances can also be linked to anxiety or stress, which are common after experiencing a traumatic event like a concussion.

Given the complexity of your symptoms, it would be advisable to consult with a neurologist first. A neurologist can conduct a thorough examination and may recommend further imaging studies, such as an MRI of the cervical spine, to assess for any structural issues that could be causing your symptoms. They can also evaluate for any signs of post-concussion syndrome and provide guidance on managing headaches and other neurological symptoms.

In addition to seeing a neurologist, you might also benefit from consulting a physical therapist. A physical therapist can help you with exercises to strengthen the neck and shoulder muscles, improve posture, and alleviate pain. They can also provide techniques for managing any nerve-related symptoms you may be experiencing.

If psychological factors are contributing to your pain or if you are experiencing anxiety or depression as a result of your injury, it may also be beneficial to speak with a mental health professional. Cognitive-behavioral therapy (CBT) has been shown to be effective in managing chronic pain and can help you develop coping strategies.

In summary, your symptoms could be related to multiple issues stemming from your concussion, including neurological, musculoskeletal, and psychological factors. A multidisciplinary approach involving a neurologist, physical therapist, and possibly a mental health professional would likely provide the best outcome for managing your chronic pain and improving your quality of life.