Pain in Patients with Polytrauma

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Investigators: Steven K Dobscha, MD, Rose Campbell, MLIS, MS, Benjamin J Morasco, PhD, Michele Freeman, MPH, and Mark Helfand, MD, MPH. Portland Veterans Affairs Healthcare System, Oregon Evidence-based Practice Center, Portland, OR Washington (DC): Department of Veterans Affairs; September 2008.

Download PDF: Complete Report, Executive Summary, Report, Appendices

Summary / Overview

Pain resulting from polytraumatic injuries poses numerous challenges during and after rehabilitation treatment. The objectives of this report are to systematically review the literature to address the assessment and management of pain in patients with polytraumatic injuries, to identify patient, clinician and systems factors associated with pain-related outcomes in these patients, and to describe current or planned research addressing the key questions in this report. The key questions were:

1. Have reliable and valid measures and assessment tools been developed to measure pain intensity and pain-related functional interference among patients with cognitive deficits due to TBI? Which measures and tools are likely to be most useful in assessing pain in polytrauma patients with cognitive deficits due to TBI?
2. What patient factors are associated with better and worse pain-related clinical outcomes among polytrauma patients? Have interventions been developed to specifically address these factors?
3. What are unique provider and system barriers to detecting and treating pain among polytrauma patients? Have interventions been developed to effectively address these barriers?

Excerpt

Polytrauma is defined in the VHA Polytrauma Rehabilitation Centers Directive dated June 8, 2005 as: "injury to the brain in addition to other body parts or systems resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability." The definition of polytrauma has since expanded to include concurrent injury to two or more body parts or systems that results in cognitive, physical, psychological or other psychosocial impairments. Traumatic Brain Injury (TBI) often occurs in polytrauma and in combination with other disabling conditions including amputation, auditory or visual impairments, spinal cord injury (SCI), post-traumatic stress disorder (PTSD), and other mental health conditions.

Pain resulting from polytraumatic injuries poses numerous challenges during rehabilitation treatment and afterwards. Treatments typically used to reduce pain in these individuals (for example, oral opioids) have the potential to interfere with the active rehabilitation needed to restore function.

The objectives of this report are to systematically review the literature to address the assessment and management of pain in patients with polytraumatic injuries, to identify patient, clinician and systems factors associated with pain-related outcomes in these patients, and to describe current or planned research addressing the key questions.

See also

• Appendix D - Reviewer comments and responses (91 KB, MS Excel)
• Appendix E - Evidence Table 1 - Studies on patient factors associated with polytrauma outcomes (132 KB, MS Excel)
• Appendix E - Evidence Table 2 - Active research projects (60 KB, MS Excel)

• Cyber Seminar on Pain in Patients with Polytrauma Including TBI
• Syntheses of the Evidence on Two Aspects of Pain Finds Little to Guide Clinicians (VA HSR&D Management e-Brief)(51 KB, PDF)
• Dobscha SK, Clark ME, Morasco BJ, Freeman M, Campbell R, Helfand M. Systematic review of the literature on pain in patients with polytrauma including traumatic brain injury. Pain Med. 2009; 10(7):1200-17.