title: Systematic review of the literature on pain in patients with polytrauma including traumatic brain injury.
abstract: OBJECTIVE
  To review the literature addressing the assessment and management of pain in patients with polytraumatic injuries including traumatic brain injury (TBI) and blast-related headache, and to identify patient, clinician and systems factors associated with pain-related outcomes.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  We conducted searches in MEDLINE of literature published from 1950 through July 2008. Due to a limited number of studies using controls or comparators, we included observational and rigorous qualitative studies. We systematically rated the quality of systematic reviews, cohort, and case-control design studies.
  
  
  RESULTS
  One systematic review, 93 observational studies, and one qualitative research study met inclusion criteria. The literature search yielded no published studies that assessed measures of pain intensity or pain-related functional interference among patients with cognitive deficits due to TBI, that compared patients with blast-related headache with patients with other types of headache, or that assessed treatments for blast-related headache pain. Studies on the association between TBI severity and pain reported mixed findings. There was limited evidence that the following factors are associated with pain among TBI patients: severity, location, and multiplicity of injuries; insomnia; fatigue; depression; and post-traumatic stress disorder.
  
  
  CONCLUSIONS
  Very little evidence is currently available to guide pain assessment and treatment approaches in patients with polytrauma. Further research employing systematic observational as well as controlled intervention designs is clearly indicated.
authors.affiliation: Portland Center for the Study of Chronic, Comorbid Physical and Mental Disorders, Portland Veterans Affairs Medical Center, Portland, OR 97207, USA. steven.dobscha@va.gov
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
authors.forename: Michael E
authors.initials: ME
authors.lastname: Clark
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Morasco
authors.forename: Michele
authors.initials: M
authors.lastname: Freeman
authors.forename: Rose
authors.initials: R
authors.lastname: Campbell
authors.forename: Mark
authors.initials: M
authors.lastname: Helfand
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology; D059408:Pain Management; D010147:Pain Measurement / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome