Pain following traumatic brain injury: Assessment and management

Abstract

Traumatic brain injury is frequently associated with painful complaints immediately after injury and subsequently. Early assessment of possible painful conditions can be made at the time of physical examination in those who are unable to give a history. Non-verbal signs of pain, including withdrawal of a painful limb or body part, irritability or tears should draw the attention of the assessing physician to a peripheral painful site. Treatment of conditions giving rise to pain can be made at this stage. Persistent pain may arise from a combination of physical and psychological factors and is best managed in a multidisciplinary pain clinic. Contributions from physicians in pain management, psychologists, physiotherapists and clinical nurse specialists enable a rehabilitation programme to take place. Treatments include analgesic drugs, graded exercise, cognitive-behavioural therapy, and transcutaneous electrical nerve stimulation. Rehabilitation of people who have ahead injury and pain takes longer than usual and separate pain management facilities should be developed for this population.

Mental Trauma Experienced by Caregivers of patients with Diffuse Axonal Injury or Severe Traumatic Brain Injury

“…Central to the trauma equation of the caregivers and the care-receivers, are the changed identity and personality, and the concomitant psyche and behavior of the TBI or DAI survivor (33). Hence in order to really understand and empathize physical and psychological trauma of TBI caregivers (34) and care-receivers (35), it is essential to institute conversations, capture and record their experience (including some quantitative measures such as assessing caregiver resilience (15)), analyze and assess to reveal the essence (including chronic pain (5)), render to fine-tune their revelation, and synthesize the compilation. A long-term longitudinal study, examining all key variables and their interactions, is warranted to fully understand trauma from severe TBI or DAI (36, 37).…”

“…Thus, in one sense, trauma applies even for mundane everyday life situations which inflict substantial mental pain, distress, and stress. Nevertheless in extraordinary intense pain (5) and stress situation involving physical, mental and psychological afflictions, trauma of care-receivers and caregivers associated with severe TBI patients, such as diffuse axonal injury (DAI), is paramount. In this short review on trauma related to TBI especially DAI, care giving is conceived as the process of intensively helping or providing assistance above and beyond the normal assistance usually given to family members and friends (6).…”

‘A light in a very dark place’: The role of a voluntary organisation providing support for those affected by encephalitis

“…Prognosis, however, is uncertain (Tyrer and Lievesley, 2003;Bajo and Fleminger., 2002). For some, significant changes in personality as well as day to day functioning can occur (McAvinue, O'Keeffe, McMackin and Robertson., 2005).…”

Crisis intervention training program: Influence on staff attitudes in a postacute residential brain injury rehabilitation setting.

“…Acquired brain injuries produce a host of physical, cognitive, and behavioral changes that can be debilitating to an individual from a functional perspective. Physical sequelae, including paresis and pain, make it difficult to engage in activities of daily living (ADLs) as well as occupational and recreational activities (e.g., Tyrer & Lievesley, 2003). Cognitive changes, including deficits in attention, memory, and executive functioning, further limit a person's capacity for functional independence (Liu, McNeil, & Greenwood, 2004).…”