Concussion patients often have unclassified, chronic pain

PHILADELPHIA — Many patients with mild traumatic brain injury have central sensitization, a pain that requires a different therapeutic approach than nociceptic pain, according to a study by Christopher File, BSA, and colleagues.

“Persistent post-concussive syndrome doesn’t happen to everyone, but it’s a significant amount of the population that experiences mild traumatic brain injury,” File, a student at the University of Texas Medical Branch in Galveston, told Healio at the American Neurological Association annual meeting. “A lot of our patients are having longstanding chronic pain for 5 to 10 years, [and there is no] rational treatment model because they’re experiencing this pain that no one is able to classify.”

File continued: “Nociceptic pain is the kind of pain you get when you’re pinched, for example, and there’s inflammation. That’s the kind of pain you can treat. But with central sensitization, you don’t have a direct answer for that pain. These people are experiencing pain where the NSAIDs don’t work, the pain medication doesn’t work, and they go into surgery, and it’s not successful. These patients don’t really have an answer as to why they’re experiencing pain and what they can actually do about it.”

Using an adapted fibromyalgia model from the Rivermead Post-Concussive Symptoms Questionnaire and the Michigan Body Map, the researchers’ preliminary data showed that patients with mTBI “have a large, widespread pain complex that we really don’t have an answer to,” File said. “But I am presenting that this might be ... an altered sensation in the brain that’s hyperattenuating. They’re experiencing hyperalgesia and allodynia that’s related to that.”

The researchers concluded that recognizing this type of pain is critical to appropriate management of those with mTBI.