Handling Pain and Acquired or TraumaticBrain Injury - Fact Sheet

The difficulties a person with brain injury faces can be even greater when pain is involved. The pain can emerge as headaches, neck and shoulder pain, lower back pain and/or pain in other body areas. The pain may be so intense and bothersome that the person withdraws from work, family and social activities.
Pain experienced by individuals with mild brain injury may prevent them from attempting to return to everyday activities despite being ready for a gradual safe return as a result of improvement in cognitive functioning. This not only serves to lengthen significantly the time before returning to activities, but it also may contribute to hesitancy and reduced self-confidence when later attempting to resume activities.

In contrast to people with mild brain injury, individuals with moderate to severe brain injury may deny or minimise the effects of their deficits. For these people, pain may reduce both awareness of their deficits and their incentive to work on improving these deficits by causing them to focus too much on their pain. The greater the deficits from the brain injury, the greater the need for family members to participate in the reduction of pain behaviours in the person with brain injury.

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 think clearly.

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.

An individual who has sustained a brain injury may face a variety of limitations including lack of awareness or insight, reduced attention and short-term memory, apathy, withdrawal and distrust of others.
First, the individual must understand the source of the pain. The pain should be explained in a manner that compensates for any cognitive deficits. Explanations should be provided in brief, concrete sentences. An understanding is needed of the benefits of treatment and how the treatment plan will help achieve these benefits.

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:

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 complaints.

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. Reasonable outcomes would include:

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 stress.

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.

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.