873 - Use of the Modified Clinically Aligned Pain Assessment (MCAPA) to Assess Pain and Functionality: A Case Report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

IY

Isaiah Yim, n/a

Medical Student
Virginia Tech Carilion School of Medicine
Roanoke, Virginia, United States

Co-Author(s)

SJ

Sunil K. Jain, MD

Assistant Professor
Carilion Clinic/Virginia Tech Carilion School of Medicine
Roanoke, Virginia, United States

Case Diagnosis: 19 yo male with traumatic spinal cord injury (SCI) secondary to motor vehicle accident (MVA).

Case Description: Patient presented with severe mid-back pain, spasticity, and paraplegia with no sensation below T7 consistent with a complete T7 ASIA-A traumatic SCI from an MVA. Patient was given methocarbamol 1000mg q6h and gabapentin 300mg TID with subsequent addition of hydrocodone/acetaminophen10/650mg q6h after T3-T9 posterolateral arthrodesis, T5 and T6 ORIF, T6 laminectomy, T3-T9 posterior instrumented fusion, and repair of traumatic CSF leak. At 5 days post-surgery, patient presented with a Modified Clinically Aligned Pain Assessment (MCAPA) score of 6/10 due to inadequate pain control and poor functionality from spasticity and severe mid-back pain. After changing methocarbamol to baclofen 10mg TID, patient experienced adequate pain control without side effects by 7 days post-op. At 13 days post-op, patient had well-controlled back pain and spasticity on baclofen without opioids. Upon discharge to inpatient rehabilitation center, patient improved to MCAPA score of 4/10 and continued to deny pain and spasticity.

Discussions: There is a need to optimize the clinical assessment and characterization of pain in order to capture the multidimensional facets of severity and experience required to effectively manage pain and improve long-term outcomes. We propose a modified CAPA with the addition of numerical values to the five aspects of pain (comfort, change in pain, pain control, functionality, and sleep) and adding dimensions for non-ambulatory patients. By conducting an analysis of this patient’s pain with MCAPA, medication changes that addressed his neuropathic pain and spasticity helped improve pain control and overall functionality.

Conclusions: MCAPA shows significant promise as a tool that can help clinicians holistically manage pain based on comfort, pain control, functionality, and sleep. Further studies are needed to assess validity on a broader scale.