TOPLINE:

Chronic pain of any type affected 40% of patients after traumatic brain injury (TBI), with bodily pain occurring more frequently than headache, new research showed. Additionally, risk for chronic pain was nearly eightfold higher in patients with preinjury migraine and nearly twofold higher in women and those with psychosocial distress.

METHODOLOGY:

• A systematic review and meta‑analysis of 28 studies included nearly 18,000 adult participants (74% men; 90% civilians and 10% military personnel) with complicated mild, moderate, or severe TBI. More than 6000 matched healthy control individuals were also included to compare pain intensity or interference.
• The primary injury mechanisms were motor vehicle crashes, falls, and violence.
• Researchers assessed the prevalence, predictors, and treatment of chronic pain (bodily, headache, or any chronic pain) after complicated mild-to-severe TBI. Average pain intensity was measured using the 36-Item Short Form Survey (SF-36) Bodily Pain subscale.
• Other outcome measures included depression symptoms on the Patient Health Questionnaire, the Pittsburgh Sleep Quality Index, the Posttraumatic Stress Disorder Checklist, and the General Anxiety Disorder-7.

TAKEAWAY:

• The pooled prevalence of any chronic pain after TBI was 40%, with chronic bodily pain (51%) more prevalent than chronic headache (31%). The overall pooled average pain intensity score was 70.7 and remained stable over 5 years.
• Significant predictors of any chronic pain included a history of military service (adjusted odds ratio [aOR], 1.4), whereas significant predictors of chronic headache were being female (aOR, 1.9), preinjury headache (aOR, 2.8), preinjury migraine (aOR, 8.0), or penetrating TBI (aOR, 2.8).
• Postinjury depression was linked to chronic bodily pain at 12 months (P < .05) and with any chronic pain (R² increase, 7%). Additional predictors for any chronic pain included sleep disturbance (R² increase, 10%), posttraumatic stress (R² increase, 8%), and anxiety symptoms (R² increase, 7%).
• In one study, botulinum toxin A injections outperformed placebo in reducing the risk for posttraumatic headache in military personnel with complicated mild TBI (mean between-group difference, -1.9 headaches per week; P = .048).

IN PRACTICE:

“Chronic pain prevalence post-TBI is clinically relevant, with ~50% experiencing bodily pain and ~30% experiencing headache. These rates generally remained consistent long-term and between civilian and military populations,” the investigators of the study wrote.

“Potentially modifiable symptoms and psychosocial factors should be included in future prognostic studies alongside work to determine the best approaches in screening for those at risk, and how to manage those with chronic pain,” they added.

SOURCE:

The study was led by Christopher Papic, PhD, The University of Queensland, Brisbane, Australia. It was published online on October 21 in PAIN.

LIMITATIONS:

The study was limited by its predominant reliance on data from North America, restricting its generalizability to other regions. The pain-focused search strategy may have missed headache-specific studies, and incomplete reporting on the bodily pain subdomain of SF-36 constrained the analysis. Sports-related studies were excluded because they mainly included cases of mild TBI that did not meet the study’s inclusion criteria.

DISCLOSURES:

The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.