Persistent Pain Drives Physical and Mental Health Decline After TBI

Persistent pain may drive declines in both physical and mental health after traumatic brain injury (TBI), according to a secondary analysis of the Transforming Research and Clinical Knowledge in TBI cohort published in the Journal of Head Trauma Rehabilitation.

Researchers from Kessler Foundation and the University of Virginia aimed to estimate the directional relationships among pain, physical health, and mental health over the first year after acute TBI. They applied cross-lagged panel modeling to longitudinal data from 1796 adults (mean age, 40.4 years; 67% men; 77% White) who reported pain on at least 2 follow-ups. Most had mild (87%) closed-head injuries (99%), primarily from motor vehicle accidents (57%) or falls (26%). Of the 1796 participants, 1025 had complete data across all 4 time points (2 weeks, 3 months, 6 months, and 12 months).

Pain was assessed using the Patient-Reported Outcomes Measurement Information System Pain Intensity and Pain Interference scales. Physical and mental health were evaluated with component scores from the 12-item Short Form Health Survey.

These data indicate that pain itself should be directly targeted by treatment interventions, as pain is more causally dominant over physical and mental health than vice versa.

A total of 89% reported pain at some point during the first year post-TBI, and 62% reported pain at all 4 follow-ups. Average pain index scores decreased from 53.8 at 2 weeks to 44.6 at 12 months, while physical health scores increased from 41.2 to 70.9 and mental health scores from 53.9 to 61.5. Pain was moderately correlated with poorer physical health (Spearman ρ, -0.52) and, to a lesser degree, with poorer mental health (Spearman ρ, -0.32), while physical and mental health were positively correlated (Spearman ρ, -0.46).

Cross-lagged structural equation modeling indicated that pain exerted stronger causal effects on both physical and mental health domains than the reverse. In the final model (comparative fit index, 0.95; root mean square error of approximation, 0.08), earlier pain scores predicted subsequent declines in physical and mental health and explained approximately 46% of the variance in 12-month pain outcomes, 40% in physical health, and 26% in mental health

Study limitations include reliance on self-reported measures, lack of data on treatment utilization, and potential unmeasured confounders such as preexisting pain or polytrauma.

“These data indicate that pain itself should be directly targeted by treatment interventions, as pain is more causally dominant over physical and mental health than vice versa,” the study authors concluded.

Disclosures: This research was supported by the National Institute of Neurological Disorders. Please see the original reference for a full list of disclosures.