title: Pain and sleep in post-concussion/mild traumatic brain injury.
abstract: Concussion after a force to the head is called mild traumatic brain injury (mTBI). Approximately 1 in 5 patients with mTBI will develop chronic pain (headache and widespread pain, possibly of central origin) and/or sleep problems (insomnia, disordered breathing, periodic limb movements). However, the predisposing mechanisms for chronic pain in patients with mTBI are unknown. Mild traumatic brain injury is a rare model to prospectively assess the risk factors and mechanisms for pain chronification from the injury onset in the absence of pretrauma comorbidity or medication. In the acute phase, headaches and sleep disturbances seem to predict the poorest long-term cognitive and mood outcomes. Although recent studies suggest that certain brain biomarkers and mood alterations (eg, anxiety, depression) contribute, the causality of chronic pain remains unclear. In mTBI patients with pain, poor sleep quality was correlated with fast beta and gamma electroencephalographic activity in frontal, central, and occipital electroencephalographic (EEG) derivations in all sleep stages. Sleep recuperative function seems to be disturbed by persistent wake EEG activity, corroborating patient complaints such as feeling awake when asleep. Pain and sleep management in mTBI is not yet evidence-based. Treatments include cognitive behavioral and light therapies, medications, and continuous positive airway pressure (CPAP) or oral appliances for disordered sleep breathing. Customized approaches are indicated for mTBI, pain, and sleep complaints. Further studies in pediatric, sport, and transportation populations are needed to prevent TBI chronification. Improvements are emerging in biomarker sensitivity and specificity and management strategies for TBI, pain, and sleep comorbidities.
authors: Departments of Medicine Family Medicine/Emergency Medicine and Neurosciences, Université de Montréal Research Centre, Trauma Unit and Centre for Advanced Study in Sleep Medicine, Hôpital du Sacré Cœur de Montréal Department of Anesthesia, McGill University Service of Neurologie, Faculty of Medicine, Hôpital du Sacré Cœur de Montréal, Canada.
authors: Gilles
authors: G
authors: Lavigne
authors: Samar
authors: S
authors: Khoury
authors: Jean-Marc
authors: JM
authors: Chauny
authors: Alex
authors: A
authors: Desautels
mesh_terms: D000818:Animals; D001924:Brain Concussion / Q000150:complications*; D001930:Brain Injuries / Q000150:complications* / Q000209:etiology*; D006801:Humans; D010146:Pain / Q000209:etiology*; D012893:Sleep Wake Disorders / Q000209:etiology*