Treatment Considerations in Traumatic Brain Injury and Pain Management

Survivors of traumatic brain injury often experience significant co-occurring pain. Pain issues cross the spectrum of severity. Pain might relate to orthopedic injury, headaches or migraines, pain secondary to spasticity and contracture, myofacial pain, disease, or other medical conditions and neuropathic sources. The experience is subjective and providers must treat it aggressively rather than solely focusing on medicating the source of pain.

We have seen a marked increase in individuals referred for services with unstable pain and prior failures in traditional pain programming. The road to wellness for a person with a brain injury and co-occurring pain disorders requires individuals to accept the challenge of pain management so that they can move on to other parts of their recovery and to life in general. As providers, we understand the following:

• Pain can be very real following a brain injury
• Pain experience is subjective
• Pain will not be eliminated or resolved completely
• Treatment must be comprehensive and not solely focused on medicating the issue
• Acceptance and positive coping of residual pain must be pursued
• Improved functional abilities and pursuit of productive activity versus inactivity is critical

Treatment goal areas include:

• Improving individual functioning during wellness activities
• Teaching individuals to positively cope with residual pain
• Working to stabilize individuals’ pain generators
• Teaching individuals to self-direct comprehensive pain plan elements
• Setting up discharge services that support wellness efforts

Throughout the treatment process, it is critical that the person with brain injury and all members of his or her treatment team remain productively engaged to ensure that the treatment plan remains comprehensive, medication changes are understood and supported, and that the plan is followed completely. Individuals committing to a comprehensive treatment program have likely struggled to manage their physical, medical and emotional conditions for a great deal of time.

Pain management is complex and challenging. Successfully achieving the goal of wellness requires the individual, their family, and the treatment team be fully engaged in the process and fully committed to productive communication. Paramount to this is that the individual take control of his or her pain and be acutely aware that there may always be some level of pain. Compliance with the treatment plan, an appropriate medication regimen, compliance with recommended exercise and stretching, following a self-care routine, developing coping skills, communication, and utilization of compensatory strategies are all critical elements to the individual’s well-being and ability to engage in productive life pursuits.

This article was contributed by Scott Peters, MS, OTR/L, Clinical Director, ReMed