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Traumatic Brain Injury and Chronic Pain Syndrome

There has been a reported overlap, or dual-diagnosis, of both traumatic brain injury (TBI) and chronic pain (CP) syndrome in many patients. This study set out to compare qualities and treatments of patients with both TBI/CP to patients with just chronic pain to gain a broader understanding of the relationship.

The most common cause of TBI was a motor vehicle accident. TBI/CP patients complained consistently of headaches, neck pain, and arm pain. TBI/CP patients also reported, "cognitive problems, impaired memory and concentration, and confusion about the etiology of their medical problems." Interestingly, there was an absence of memory and concentration problems in those patients with only chronic pain. The researchers feel the differences in concentration and memory symptoms are indicative of the general patient population, and not limited to their study.

The researchers conclude:

"We propose that the CP patients who endorse or complain of memory or concentration problems, who express confusion about their diagnosis, complain of pain in head, neck, and arms, and/or were injured in motor vehicle accident should be further questioned about the possibility of concurrent TBI."

Treatment outcome of patients with dual diagnosis is similar to patients with CP alone, although treatment length tends to be longer.

One important finding of this study was that dual diagnosis is apparently more common than previously thought. When the researchers were looking for the chronic pain patients without a history of TBI to use as a comparison group, 17% had to be disqualified because of a history of head injury. None of these patients had been evaluated or treated for TBI.

Andary MT, Crewe N, Ganzel SK, et al. Traumatic brain injury/chronic pain syndrome: a case comparison study. The Clinical Journal of Pain 1997;13:244-250.