Pain following traumatic brain injury: Assessment and management

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.