No one talks about how people who have a brain injury also have pain everywhere. I mean, after a TBI, everything hurts. And when you ask doctors about it, they say it’s psychological. But it sure doesn’t feel that way. Why is this happening, and what can I do?
Studies show that more than 50 percent of people suffer from chronic pain disorders in the years following a brain injury. Headaches and neuropathic (nerve-related) pain is most commonly from 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. Interestingly, people with milder brain injury have higher rates of complaints of headaches when compared to those with moderate and severe brain injury. The reason for the higher rates of headaches with milder severity brain injury is not well understood.
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.
Please refer to this comprehensive article regarding the treatment of headaches.
More on TBI-related headaches.
Spasticity is another cause of pain more commonly seen after moderate to severe brain injury.
Watch this video with Dr. Greenwald about TBI-related spasticity.
Dr. Brian Greenwald is medical director of Center for Head Injuries and the associate medical director of JFK Johnson Rehabilitation Institute. He is a clinical associate professor in the Department of Physical Medicine and Rehabilitation at UMDNJ-Robert Wood Johnson Medical School.