title: Finding the person behind the pain: chronic pain management in a patient with traumatic brain injury.
abstract: Chronic pain is common after a traumatic brain injury. Cognitive impairment post injury may be a consequence of the brain injury alone, or in combination with pain, clinical depression, and psychological and emotional factors. We present a case of a severely cognitively impaired person post-traumatic brain injury, whose behavior included social withdrawal, irritability, and agitation around direct care--which was unresponsive to psychotropic intervention or care delivery strategies. The introduction of an opioid made a significant improvement in the cognition and quality of life of the individual. This case suggests that clinicians should consider a trial of opioid analgesics in individuals with brain injury who have significant cognitive impairment in association with other behaviors suggestive of depression and pain.
authors.affiliation: Division of Residential Care, Providence Health Care, 1081 Burrard Street, Vancouver, BC, Canada. rgallagher@providencehealth.bc.ca
authors.forename: Romayne
authors.initials: R
authors.lastname: Gallagher
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Drance
authors.forename: Susan
authors.initials: S
authors.lastname: Higginbotham
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications*; D002908:Chronic Disease; D003072:Cognition Disorders / Q000209:etiology; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D007508:Irritable Mood; D008134:Long-Term Care; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D009730:Nursing Assessment; D009735:Nursing Homes; D009740:Nursing Staff / Q000193:education; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D010147:Pain Measurement; D010166:Palliative Care; D010347:Patient Care Planning; D011595:Psychomotor Agitation; D011788:Quality of Life / Q000523:psychology; D012934:Social Isolation; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid