The following is a summary of “Mechanisms and treatments of chronic pain after traumatic brain injury,” published in the October 2023 issue of Neurology by Chen et al.

Persistent pain following trauma is a common occurrence, yet some trauma survivors endure prolonged pain lasting months to years post-injury. A notable example prevalent in both combat and civilian contexts is chronic pain after traumatic brain injury (TBI). Affected individuals often experience persistent pain in areas such as the head, back, and extremities. This TBI-related chronic pain can either manifest independently or exacerbate prevailing pain stemming from other injuries long after the initial healing phase. The implications of chronic pain in these scenarios are profound, contributing to heightened suffering, increased disability levels, severe emotional distress, and exacerbated cognitive impairments. 

This comprehensive review delves into recent findings that shed light on the dysfunction of innate pain-regulating mechanisms, neuroplastic alterations in trigeminal circuitry, and spinal nociceptive processing, all contributing to chronic pain following TBI.

Central pain modulatory regions like the locus coeruleus, periaqueductal grey matter, and rostroventromedial medulla are particularly susceptible to TBI-induced impairment. This review scrutinizes the underlying rationale and existing evidence supporting diverse therapeutic interventions, including monoamine reuptake inhibitors, CGRP antagonists, CXCR2 chemokine receptor antagonists, and interventional therapies. While consensus guidelines for managing chronic post-traumatic TBI-related pain remain elusive, this study emphasizes the need for rigorous evaluation of multiple approaches in addressing this clinically complex situation. These strategies hold promise as potential therapeutic options deserving focused attention and exploration despite the need for established protocols for their implementation.

Source: sciencedirect.com/science/article/abs/pii/S0197018623001584