The Journal of head trauma rehabilitation
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J Head Trauma Rehabil · Jan 2004
ReviewPain pathoetiology after TBI: neural and nonneural mechanisms.
Individuals recovering from traumatic brain injury (TBI) frequently experience acute and chronic pain. Their pain experience is the net effect of many interacting and very complex physiologic, biochemical, and psychological mechanisms involving both the peripheral and central nervous system. ⋯ Numerous intracranial and extracranial tissues must be considered in the evaluation of pain after TBI, with the specific mechanism of trauma influencing the anatomic distribution of injuries. The differential diagnosis usually falls into one of the following pathoetiologic classifications: primary or secondary musculoskeletal, vascular, visceral, and neural pain syndromes.
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J Head Trauma Rehabil · Jan 2004
ReviewPsychological, neuropsychological, and medical considerations in assessment and management of pain.
Pain is a common yet challenging problem, particularly following traumatic injuries to the head or neck. It is a complex, multidimensional subjective experience with no clear or objective measures; yet it can have a significantly disabling effect across a wide range of functions. Persisting misconceptions owing to mind-body dualism have hampered advances in its understanding and treatment. ⋯ A biopsychosocial assessment model is presented to guide understanding of the myriad of factors that contribute to chronicity. A brief survey of general classes and samples of the more useful pain assessment instruments is included. Finally, this model offers a rational means of organizing and planning individually tailored pain interventions, and some of the most useful pharmacologic, physical, and behavioral strategies are reviewed.
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J Head Trauma Rehabil · Jan 2004
ReviewPsychological and neuropsychological integration in multidisciplinary pain management after TBI.
The intersection of traumatic brain injury and posttraumatic chronic pain poses a significant challenge for the health practitioner. Effective intervention requires psychological and neuropsychological evaluation, multidisciplinary teamwork, and an understanding of a wide range of pain disorders and their relationship to traumatic brain injury. ⋯ Coordinated care requires multiple, ongoing interventions from a variety of specialists. Patient involvement, focusing on internal locus of control, mediates successful treatment.
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J Head Trauma Rehabil · Jan 2004
Occipital nerve blocks in postconcussive headaches: a retrospective review and report of ten patients.
Headaches are common following traumatic brain injuries of all severities. Pain generators may be in the head itself or the neck. Headache assessment is discussed. ⋯ Finally, a retrospective study of 10 postconcussive patients with headaches who were treated with greater occipital nerve blocks is presented. Following the injection(s), 80% had a "good" response and 20% had a "partial" response. Occipital nerve block is a useful diagnostic and treatment modality in the setting of postconcussive headaches.