Studies have shown that over 50 percent of people suffer from chronic pain disorders in the years following a brain injury. Headaches and neuropathic (nerve-related) pain are commonly caused by injury to the head and neck. Other common sources of pain include spasticity (increased muscle tension from brain injury), heterotopic ossification (bone forming outside the skeleton), deep venous thrombosis, genitourinary and gastrointestinal disorders, and orthopedic trauma (ie, fractures and other muscle and bone injuries). The head is the most common location of pain. Those with mild brain injury have the highest rates of complaints due to headaches in comparison to those with moderate and severe brain injury.
Doctors can effectively treat pain by identifying it, quantifying it, reviewing the history of the person’s pain, and understanding how it limits function. Memory and language problems may limit effective communication for some people with TBI, increasing the complexity of evaluation of where the pain is coming from. A careful evaluation including discussion with other treating clinicians and family members may be required is some cases for effective evaluation.
Treatment of pain is a balancing act when considering medications since many medications to treat pain can worsen memory and cause sleepiness, especially in the opioid and antidepressant classes. Patients with TBI may be even more vulnerable than other patients to the cognitive side effects of certain pain medications. Because of this, the use of non-sedating analgesics (eg, acetaminophen, non-steroidal anti-inflammatory drugs, and transdermal lidocaine patches) should be a first line in treating pain in patients with TBI. Mood disturbance can be caused by chronic pain or worsen chronic pain and needs to be addressed as part of treatment.