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Characterization and Treatment of Chronic Pain After Traumatic Brain Injury-Comparison of Characteristics Between
Cynthia Harrison-Felix1, Mitch Sevigny, Cynthia L Beaulieu
1Craig Hospital Research Department, Englewood, Colorado (Drs Harrison-Felix and Ketchum, Mr Sevigny, and Ms Peckham); Department of Physical Medicine and Rehabilitation, The Ohio State University College of Medicine, Columbus (Dr Beaulieu); Baylor Scott and White Institute for Rehabilitation, Dallas, Texas (Ms Callender); Icahn School of Medicine at Mount Sinai, New York, New York (Dr Dams-O'Connor); Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, Michigan (Dr Hanks); Mental Health and Behavioral Science Service (Dr Martin) and MHBS/Polytrauma (Dr Nakase-Richardson), James A. Haley Veterans Hospital, Tampa, Florida; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida (Dr Martin); Department of Physical Medicine and Rehabilitation, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham (Ms Marwitz); Department of Physical Medicine and Rehabilitation, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Dr Rabinowitz); H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Sander); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, and Harvard Medical School, Boston, Massachusetts (Ms Sterling); Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond (Dr Walker); Sleep and Pulmonary Division, Department of Internal Medicine, University of South Florida, Tampa, and Defense Health Agency Traumatic Brain Injury Center of Excellence, Tampa, Florida (Dr Nakase-Richardson); and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle (Dr Hoffman).
Objective:
To estimate the prevalence of chronic pain after traumatic brain injury (TBI) and identify characteristics that differ from those without chronic pain.
Setting:
Community.
Participants:
A total of 3804 TBI Model Systems (TBIMS) participants who completed the Pain Survey at TBIMS follow-up.
Design:
A multisite, cross-sectional observational cohort study.
Main Outcome Measures:
Functional outcomes, pain experience, and treatment.
Results:
46% reported current chronic pain, 14% reported past (post-injury) chronic pain, and 40% reported no chronic pain. Bivariate differences in sociodemographic and injury characteristics between the 3 pain groups were generally small in effect size, reflecting little clinical difference. However, medium effect sizes were seen for all functional outcomes, such that individuals with current chronic pain had worse functional outcomes compared with individuals in the past pain or no pain groups. Treatment utilization rates were higher for individuals with current chronic pain compared with past pain, with medical treatments being most frequently utilized. Individuals with past pain perceived more improvement with treatment than did those with current chronic pain as represented by a large effect size.
Conclusions:
Chronic pain affects approximately 60% of those living with TBI. The implications of chronic pain for functional outcomes support inclusion of pain metrics in prognostic models and observational studies in this population. Future research is needed to proactively identify those at risk for the development of chronic pain and determine the efficacy and access to pain treatment.
