Examining the relationship and clinical management between traumatic brain injury and pain in military and civilian populations

Abstract

In this review, we discuss the comorbidity of traumatic brain injury (TBI) and pain among civilians and military members, the common causes of pain resulting from TBI, and offer insight about the therapeutic management of TBI symptoms and pain. Traumatic brain injury (TBI) is a debilitating health problem and one of the most common post-TBI symptoms is pain, which can contribute to psychological issues such as Post-traumatic stress disorder (PTSD) and depression. Headache pain appears to be the most common type of pain that results from TBI, yet pain can also be more widespread. Managing TBI symptoms and pain simultaneously is difficult because extensive randomized control and clinical studies assessing the effectiveness of therapeutic approaches are lacking. Pharmacological agents such as antidepressants and Triptans and nonpharmacological therapies such as cognitive rehabilitation and physical therapies are commonly used yet it is unknown how effective these therapies are in the long-term. A combination of pharmacological and non-pharmacological therapies is often more effective for managing TBI symptoms and pain than either treatment alone. However, future research is needed to determine the most therapeutic approaches for managing the comorbidity of pain and TBI symptoms in the long term. This review offers suggestions for such future studies.

The intersection of lifetime history of traumatic brain injury and the opioid epidemic

“…One multi-center study found that over 70% of people receiving acute rehabilitation after TBI were prescribed opioids during their hospital stay (Hammond et al, 2015). Persons with persistent post-concussive symptoms after TBI are also more likely to be prescribed opioids (Mehalick & Glueck, 2018;Seal et al, 2018). In addition to the known addictive properties of long-term opioid therapy (Chou et al, 2015;Dowell, Haegerich, & Chou, 2016), individuals with TBI may be more susceptible to OUD compared to those without a history of brain injury.…”

Identifying Veterans in Your Practice: What Clinicians Need to Know

“…19 If a blast-related, mild TBI injury occurs, accompanying problems with head, neck, or back pain, or a combination of these, may emerge. 20 It is vitally important for primary care providers to complete a veteran-centric military health history because the potential for a TBI during training or deployment is high. TBI can mimic a variety of conditions.…”

Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms

“… Indeed, the only published trial of behavioral treatment for PTH found no benefit in a civilian sample. Veterans with PTH may respond to treatment differently than civilians owing to a higher risk of comorbid PTSD symptoms, but at the time of this article, there are no published randomized clinical trials in veterans for any PTH intervention.…”