Persistent pain following traumatic brain injury in a pediatric population

Abstract

Children experience many complications following traumatic brain injury (TBI) including pain. Chronic headaches have been identified as common sequelae of post-concussive syndrome; however, few studies describe pain involving other sites. Thus, we aimed to examine the persistence of pain (headache and non-headache pain) up to 24 months after TBI and its associated clinical and psychosocial risk factors. We performed secondary data analyses from a longitudinal study of disability in children after TBI. The sample included 307 adolescents (ages 14 to 17 years), 246 with TBI and 61 with orthopedic injury (OI) representing a comparison cohort. At 3, 12, and 24 months after injury, adolescents reported on the presence of pain, pain location and intensity, and depressive symptoms. Persistent pain was defined as pain present at each assessment wave (3, 12 and 24 months). The majority of adolescents with TBI were classified with mild I/II TBI (n = 171) or mild III TBI (n = 39), and fewer with moderate or severe TBI (n = 36). Pain was commonly experienced after head and orthopedic injury. Significant group differences were found: adolescents with mild I/II TBI having the highest rate of persistent pain (39.2%) compared to adolescents with mild III TBI with the lowest rate (12.8%, p < .01). Pain intensity and location were similar for TBI and OI groups, involving most commonly the head, upper and lower extremity, and back. Risk factors for persistent pain included female gender (OR1.64, 95% CI 1.06, 2.53) and pain at 3 months post-injury (OR 1.51, 95% CI 1.35, 1.68) after accounting for injury severity and depressive symptoms. Findings suggest that a notable proportion of adolescents experience persistent pain up to 24 months after TBI. Future research is needed to focus on early assessment of pain and to understand potential treatment needs.