Persistent pain following concussion
The authors of this article aimed to investigate the prevalence of persistent pain associated with Mild Traumatic Brain Injury (mTBI).
Persistent pain is a very common, but difficult thing to address clinically, and the authors start by acknowledging the Stedman Medical Dictionary definition of pain:
“An unpleasant sensation associated with actual or potential tissue damage, and mediated by specific nerve fibres to the brain where its conscious appreciation may be modified by various factors.”
This definition notably acknowdledges that injury does not always result in pain and pain is not always caused by injury. Thus, fully addressing pain can be a difficult in the wider clinical picture.
For this article, the authors focused on additional social demographics, clinical presentation and behavioural variants to determine which factors would likely indicate an increased risk for persistent pain.
This article examined 94 patients who had been diagnosed with mTBI.
A VAS was used to subjectively note a patient’s reported pain levels. The authors also used information such as the patient’s medical history, noting personal factors such as mood disorders, sleep disorders, anxiety or substance-related medical history.
Additional injury factors, such as the nature of the mTBI, work status at the time of injury and tension with the insurer around the injury were recorded. These findings were catalogued as additional factors that could be impacting pain.
All information was collected and categorized into factors that are impacting on-going head/ neck and bodily pain following mTBI.
The researchers found that several variables impacted the on-going reporting of head, neck and body pain following mTBI.
Male patients who had fallen or experienced mTBI related to an explosion reported more pain than those who had a different mechanism of injury.
Moreover, interesting facts were found regarding sleep (a.o. that women who reported more sleep disturbances had higher rates of pain than those that didn’t).
Other occupational differences between males and females were noted: women reported less pain if they were working >40 hours per week at the time of the injury, whereas men who worked >40 hours a week at the time of injury had greater reports of pain.
This article provided a wide array of data and discussion around the contributing factors to pain following mTBI. While the proposed clinical treatment approaches were not well discussed, it did highlight the need for a multi-disciplinary approach to mTBI treatment.
Furthermore, going simply on the length of loss of consciousness (LOC) and mechanism of injury is not enough to provide a clear clinical plan. All aspects need to be considered to provide a bespoke and multi-disciplinary approach for treatment.
> From: Mollayeva et al., Medicine 96 (2017) e5917. All rights reserved to Medicine. Click here for the online summary.