Traumatic Brain Injury (TBI) Pain Phenomena
by Glenna Tolbert, MD
 As a result of aggressive interventions and rehabilitation,
traumatic brain injury (TBI) patients are living longer. The bad news is that TBI patients
are living longer with pain. Patients and families may become frustrated due to the
possibility of living with intractable pain. It is well established that pain is often
left underappreciated and undertreated in cognitively-impaired patients. Common
neurological complications after traumatic brain injury include pain, spasticity, and late
functional decline. Pain may be acute or chronic. Pain may be musculoskeletal, neuropathic
(“nerve pain”), or secondary to medical complications.
A cookbook pain management approach, particularly for persons with traumatic brain
injury, is inappropriate. Individualized pain management is required. Therefore the
following article provides some caveats and is supplemented by patient care experiences.
Background
More than 90 percent of wounded soldiers—the highest survival rate in American
wars—have made it off the battlefield. The increased survival rates have increased
for both military and civilian TBI victims.
Because of advances in evaluation and treatment of individuals after traumatic brain
injury (TBI), the number of co-morbidities has risen. With the invention of Computed
Tomogram (CT) in the 1970s, diagnosing life-threatening events resulted in many saved
lives and a better understanding of TBI. Because many of the brain injuries involve motor
vehicle accidents and falls, concurrent bodily injury frequently accompanies the event.
Some researchers estimate that the rate of posttraumatic headaches approaches 90% early on1
or 44% within six months after injury.2 Unlike what is seen objectively on
sophisticated scans, pain is never clearly understood because the suffering is subjective.
Please refer to the April 2010 issue for the complete text. In the event you need to order a back issue, please click here.
— April 2010
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