title: Traumatic brain injury/chronic pain syndrome: a case comparison study.
abstract: OBJECTIVE
  To identify the pretreatment characteristics and progress in treatment and outcomes of chronic pain patients, with and without concomitant traumatic brain injury (TBI).
  
  
  METHODS
  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.
  
  
  METHODS
  Interdisciplinary university-based outpatient rehabilitation medicine clinic.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: College of Osteopathic Medicine, Michigan State University, East Lansing 48823, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Andary
authors.forename: N
authors.initials: N
authors.lastname: Crewe
authors.forename: S K
authors.initials: SK
authors.lastname: Ganzel
authors.forename: C
authors.initials: C
authors.lastname: Haines-Pepi
authors.forename: M R
authors.initials: MR
authors.lastname: Kulkarni
authors.forename: D F
authors.initials: DF
authors.lastname: Stanton
authors.forename: A
authors.initials: A
authors.lastname: Thompson
authors.forename: M
authors.initials: M
authors.lastname: Yosef
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000523:psychology*; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D012189:Retrospective Studies