Research Reports - Pain with traumatic brain injury and psychological disorders

Prog Neuropsychopharmacol Biol Psychiatry. 2017 Jun 13. pii:
S0278-5846(17)30333-0. doi: 10.1016/j.pnpbp.2017.06.007. [Epub ahead of print]

Khoury S(1), Benavides R(2).

Traumatic brain injury (TBI) is the cause for long-term disability in more than 3
million patients in the US alone, with chronic pain being the most frequently
reported complain. To date, predisposing mechanisms for chronic pain in TBI
patients are largely unknown. Psychological disorders, including post-traumatic
stress disorder, depression and anxiety following TBI are commonly reported
comorbidities to post-traumatic pain. Long term consequences can be debilitating
and affect quality of life even when the injury is mild. In this review, we
present the most commonly reported chronic pain conditions across the spectrum of
severity of TBI, mainly focusing on mild TBI. We discuss chronic post- traumatic
headaches, widespread pain as well as post-traumatic central pain. We discuss
pain in the context of injury severity and military versus civilian populations.
We are only starting to understand the biological mechanisms behind
post-traumatic pain and associated psychological distress following TBI, with
genetic, biochemical and imaging studies pointing to the dopaminergic,
neurotrophic factors and the role of Apolipoprotein. Physiological and
neurological mechanisms are proposed to partially explain this interaction
between post-traumatic pain and psychological distress. Nevertheless, the
evidence for the role of structural brain damage remains incomplete and to a
large extent debatable, as it is still difficult to establish clear causality
between brain trauma and chronic pain. Finally, general aspects of management of
chronic pain post-TBI are addressed. 

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