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Traumatic Brain Injury/Chronic Pain Syndrome: A Case Comparison Study

Andary, Michael T. M.D.; Crewe, Nancy Ph.D.; Ganzel, Steven K. D.O.; Haines-Pepi, Carolyn M.S., R.D.; Kulkarni, Madhav R. Ph.D., O.T.R.; Stanton, Donald F. D.O.; Thompson, Ann Ph.D.; Yosef, Matheos M.S.

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Objective: To identify the pretreatment characteristics and progress in treatment and outcomes of chronic pain patients, with and without concomitant traumatic brain injury (TBI).

Design and Patients: Retrospective cohort study of 12 consecutive patients in a chronic pain treatment program who were discovered to have previously untreated brain injury and a cohort of 12 chronic pain patients from the same program matched for age and sex who did not have brain injury.

Setting: Interdisciplinary university-based outpatient rehabilitation medicine clinic.

Main Outcome Measures: Length of time in treatment and vocational outcomes.

Results: A surprising number of patients referred for treatment of chronic pain were found to have history and symptoms indicative of previously untreated or undiagnosed mild traumatic brain injury (n = 21 of 65). Of these, 12 received therapy for both their brain injury and chronic pain. The 12 treated, dual diagnosed patients did not differ in terms of education, employment status, or marital status from the chronic pain patients. Those with TBI were more likely to have sustained an automobile injury and less likely to have a work-related injury. On admission, 25% of each group were working, and at discharge, that proportion reached 75% for each group. Those with TBI required significantly longer treatment (459 consecutive days) from intake to discharge compared with the control group (295 days).

Conclusion: Patients who exhibit memory or concentration problems, who express confusion about their diagnosis, who were injured in an automobile accident, or who complain of pain in the head, neck, or arms should be questioned about the possibility of concurrent TBI. Most of these patients can achieve successful employment outcomes, however, the TBI group may require a longer treatment time.

College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, U.S.A.

Manuscript submitted February 1, 1996; revision received February 18, 1997; accepted for publication May 1, 1997.

Address correspondence and reprint requests to Dr. Michael T. Andary, College of Osteopathic Medicine, B-401 West Fee Hall, Michigan State University, East Lansing, MI 48823, U.S.A.

This work was presented in part at the meeting of the American Academy of Physical Medicine and Rehabilitation, November 1992.

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