Pain management & brain injury
Pain can be one
of the many resulting effects from a brain injury and it needs
Acute pain starts quickly and is
generally short-lived. Chronic pain is more
persistent and usually lasts beyone the normal time for
Pain management is important to maintain a reasonable quality of
life, as the effects of chronic pain include:
- Faster heart rate and higher blood pressure
- Potential mental health disorders e.g. anxiety and
- Increased stress, fatigue and tension
- Gastrointestinal issues.
Early detection of pain and appropriate management are
important as otherwise the person may adopt negative ways to cope
with the pain. Some of the more frequent causes for
pain following a brain injury are:
- Headaches and migraines
- Neck and shoulder pain (after traumatic brain injuries)
- Abscess and skin sores
- Cervical or spine injuries
- Heterotopic ossification (bony overgrowth)
- Kidney stones and bladder infections
Chronic pain can lead to depression, anger and anxiety disorders
as sufferers may have many other negative events and stressors to
deal with such as losing their jobs, experiencing financial
hardship and having increased stress upon their families. With
chronic pain, people may believe the pain is increasing even though
there is no medical evidence for this. In these cases other factors
are at play including:
- Emotional functioning
- Personality traits
- Past learning experiences
- The way others respond to the person's behaviour.
Sleep and appetite disturbances intensify the disability that
results from chronic pain. As time goes by, the person may become
depressed and preoccupied with normal changes in bodily functioning
and may worry about experiencing new illnesses.
The individual can develop a tendency to view all activities in
terms of how much pain will be experienced. This can lead to a
cycle of helplessness and despair, often accompanied by anger
toward professionals who never seem to be able to cure the pain. In
turn, professionals lose patience with the person with persistent
pain who appears to have limited medical justification for these
Pain management strategies are usually based on one ultimate and
constant objective-the reduction of pain, not its total
elimination. If the person experiencing the pain and all of the
professionals who treat the individual do not make this the goal,
frustration will grow, resulting in failure to coordinate treatment
efforts in a successful manner.
Research has shown that having realistic, helpful thoughts is an
important part of pain management. Cognitive behavioural
psychologists help chronic pain sufferers to change their negative
thoughts about their pain, its effects, and other sources of
One approach views pain as a learned behaviour and is done by a
psychologist or neuropsychologist. Other approaches help the person
to identify inappropriate and unhealthy beliefs about pain and
provide strategies to deal more effectively with pain behaviour.
Techniques may include relaxation training, hypnosis, stress
management, attention-diversion strategies and biofeedback.
Pain management in brain injury is often difficult as
medications may work against recovery. Many painkillers work
against the re-emergence of the person's mental and physical
systems. Later, narcotics are a problem because of their potential
for substance abuse and their negative side effect on the ability
Anti-inflammatory agents are appropriate for musculoskeletal
pain, though doctors must stay alert for possible gastric problems.
Patients with brain injury and spinal cord injury tend to have high
acid content in the stomach and are susceptible to stomach ulcers
which can be increased by these agents.
Antidepressants can be effective in controlling headache and
nerve pain. These are not sedating except in high doses, and don't
depress the respiratory cycle.
Where to get help
There are support groups and medical facilities set up to help
people cope with chronic pain. Ring your local doctor or Brain
Injury Association to get the contact details in your State.