Traumatic brain injury, polytrauma, and pain: Challenges and treatment strategies for the polytrauma rehabilitation


Gironda, R.J., Clark, M.E., Ruff, R.L., Chait, S., Craine, M., Walker, R., & Scholten, J. (2009). Traumatic brain injury, polytrauma, and pain: Challenges and treatment strategies for the polytrauma rehabilitation. Rehabilitation Psychology, 54(3), 247-258.


 This article includes an overview of the different types of pain commonly experienced by veterans and service members managing polytraumatic injuries, including a review of posttraumatic headaches after mild to severe TBI. The authors discuss the unique constellation of symptoms veterans may experience that contribute to pain, which includes both the emotional and physical impact of polytrauma injuries. Information is provided on different interventions for posttraumatic headache pain and non-headache pain, including the risks and benefits of utilizing pharmacological interventions, and the utility of cognitive-behavioral based approaches to pain management in the rehab setting. The authors also offer suggestions surrounding the assessment of pain, and the challenges providers may face in accurately assessing pain in patients with moderate to severe TBI. Finally, the authors provide suggestions regarding a system of care for pain management for veterans and service members managing multiple somatic and cognitive symptoms of varied etiology, a condition referred to as “post-deployment multi-symptom disorder” (PMD). The authors suggest that an effective system of care for PMD would include a range of cognitive, emotional, physical, and psychosocial interventions, with the aim of preventing the development of “long-term disability” due to chronic pain.

 I CHOSE THIS ARTICLE BECAUSE pain is often a barrier to both acute rehabilitation, and long-term recovery for individuals managing complex injuries. Pain can become especially challenging to treat when patients experience a TBI in addition to bodily injuries, so I appreciate the author’s explanation of the different ways of assessing and treating pain, as it lends itself to an interdisciplinary team approach to pain management, which can be crucial in a rehab setting. I also enjoyed the author’s discussion about the constellation of symptoms that can occur after war-related injuries, as these cases often warrant a unique approach to rehabilitation and pain management. Overall, I found this to be a resourceful article for understanding the origin of, function of, and treatment of pain after polytrauma, and would recommend it for those treating pain in both acute and post-acute polytrauma rehabilitation settings.

 THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chosen by Janette Hamilton, Ph.D. Staff Psychologist at the Hunter Holmes McGuire VA Medical Center, Richmond, Virginia