JAMDA
Volume 7, Issue 7 , Pages 432-434, September 2006

Finding the Person Behind the Pain: Chronic Pain Management in a Patient With Traumatic Brain Injury

  • Romayne Gallagher, MD, CCFP

      Affiliations

    • Division of Residential Care, Providence Health Care, Vancouver, BC, Canada
    • Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
    • Corresponding Author InformationAddress correspondence to Romayne Gallagher, MD, CCFP, Division of Residential Care, Providence Health Care, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.
    • ,
  • Elisabeth Drance, MD, FRCP(C)

      Affiliations

    • Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
    • ,
  • Susan Higginbotham, RN

      Affiliations

    • Division of Residential Care, Providence Health Care, Vancouver, BC, Canada

published online 18 July 2006.

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.

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 R.G. accepts honoraria for educational presentation by Purdue Pharma, makers of long-acting oxycodone.R.G. wrote the paper with contribution and feedback from E.D. and S.H.The patient in this case report is not capable of giving informed consent. We have consent from her daughter.No funding was required.

PII: S1525-8610(06)00253-2

doi:10.1016/j.jamda.2006.04.010

JAMDA
Volume 7, Issue 7 , Pages 432-434, September 2006

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