Chronic Pain and Traumatic Brain Injury

After a traumatic brain injury (TBI), a large number of individuals experience chronic pain (i.e., pain that lasts at least three months) that may or may not be directly related to the TBI. Over 70% of non-military individuals and 80% of active military and veterans have reported chronic pain after TBI. Living with chronic pain impacts almost all aspects of a person’s life: physical function, concentration and memory, sleep, and feelings of depression, anxiety and irritability. It has been difficult to identify effective treatments because large studies of individuals with TBI and chronic pain have not been conducted. This study leverages an existing successful research network (TBI Model Systems – TBIMS) that has the largest number of individuals with TBI who have been enrolled and followed in a well characterized, long-term database related to TBI.

The aims of this study are to: 1) Determine chronic pain classification (musculoskeletal, headache, central/neuropathic), prevalence, location, duration, and associations with demographic, injury severity, current level of functioning and comorbidities in participants followed in 18 Centers participating in the National Institute on Disability, Independent Living and Rehabilitation Research and the Department of Veterans Affairs TBIMS Databases; 2) Identify extreme groups based on responses to pain (interference and perception of improvement with treatment), or chronic pain extreme phenotypes, in order to define the key differences between those who have a good outcome and those who do not, across factors related to injury, pain severity/location, demographics, and treatment history; and 3) Identify treatment practices by clinicians who treat comorbid TBI and chronic pain to determine gaps in availability/accessibility of guideline level treatment, highlighting underserved populations where applicable.

Results from this study provide a more detailed picture of the problem of chronic pain after TBI by examining the types of pain that occur after TBI, which may be multiple types of pain for a subset of individuals, as well as the frequency of comorbid conditions. Identifying extreme phenotypes, such as demographic, individual, and treatment factors associated with those who have chronic pain but have minimal interference compared to those who are significantly impacted by pain, allows us to identify treatment targets (behavioral, cognitive, biological, and molecular) to advance a personalized medicine approach to treatment unlike any approach in TBI and chronic pain to date. Outcomes from this study include educational materials on chronic pain and pain treatment to benefit patients, family members, clinicians, and policymakers. Data from this study have a direct impact on clinical practice, informing future work, and promoting understanding of constituent factors in extreme phenotypes.