Study Uncovers High Incidence of Chronic Pain after TBI

A new study published in the Journal of Head Trauma Rehabilitation (JHTR) found that chronic pain affects approximately 60 percent of traumatic brain injury (TBI) survivors, with some respondents reporting chronic pain up to 30 years post-injury. The research surveyed patients who were being followed in 18 TBI Model System centers, a research program that includes 16 civilian and 5 veteran rehabilitation centers in the U.S.

“We have known for some time that chronic pain frequently co-occurs with chronic brain injury,” said John D. Corrigan, PhD, national research director of the Brain Injury Association of America and editor-in-chief of JHTR. “Clinically, it can both limit independence and diminish well-being. This series of studies has demonstrated empirically that indeed it is both frequent and disruptive.”

All 3,804 respondents had been hospitalized with moderate to severe TBI. Time since injury ranged from one to 30 years, with the average time since injury being five years.

Cynthia Harrison-Felix, PhD, FACRM, co-project director of the TBI Model System at Craig Hospital in Englewood, Colo., said this is the first study that examines the experience of chronic pain in a large TBI sample this far post-injury. “Pain status did not differ significantly across follow-up years,” she added. “While our data are not longitudinal, it suggests that chronic pain occurs at varying points after injury, and may interfere with initial recovery and long-term, necessitating proactive pain assessment and treatment.”

The survey informed participants that chronic pain can be defined as “persistent or recurring pain that lasts longer than three months. It includes headaches or pain anywhere in the body, which occurs more than half of the days over a three-month period.” When study participants were asked for specifics about their own pain, key results included:

• 46 percent reported current chronic pain
• 14 percent reported past chronic pain (after TBI)
• 40 percent reported no chronic pain
• 32.5 percent of participants with current chronic pain reported constant pain
• Compared with participants who reported no chronic pain after TBI or only past chronic pain, those with current chronic pain had significantly worse results on all three outcome measures included in the survey: the Functional Independence Measure motor and cognitive subscores, the Disability Rating Scale, and the Glasgow Outcome Scale–Extended

Medications, physical therapy, and home exercise programs were the pain treatments most commonly reported amongst respondents. Medications were used by 91 percent of participants with current chronic pain and had been used by 90 percent of those with past chronic pain. The least frequently reported treatment was comprehensive chronic pain rehabilitation.

The researchers concluded that chronic pain should be assessed and treated along with other neurocognitive and neurobehavioral disorders such as memory deficits and depression, and that while the directionality of the relationship between pain and outcomes cannot be assessed, the findings indicate that the presence of chronic pain after TBI is “far from benign.”

Professionals who are interested in learning more about the correlation between chronic pain and TBI are encouraged to sign up for BIAA’s upcoming webinar, “Chronic Pain and TBI,” being held Tuesday, Jan. 9, at 3 p.m. ET. Jeanne Hoffman, PhD, ABPP, and Risa Nakase-Richardson, PhD, FACRM, will cover the most frequent types of pain and the role of comorbidities in people with TBI and chronic pain, possible barriers and facilitators for engagement in pain treatment for people with TBI, and more.