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, 96 (7), e5917

Concussion/mild Traumatic Brain Injury-Related Chronic Pain in Males and Females: A Diagnostic Modelling Study

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Concussion/mild Traumatic Brain Injury-Related Chronic Pain in Males and Females: A Diagnostic Modelling Study

Tatyana Mollayeva et al. Medicine (Baltimore).

Abstract

Pain is an unpleasant, complex, and perceived experience that places a significant burden on patients and clinicians. Its severity may be mediated by emotion, attitude, and environmental influences, and pain may be expressed differently in males and females. Traumatic brain injury (TBI) is frequently associated with chronic pain. This diagnostic modeling study examined sex differences in the construct of chronic pain in patients with delayed recovery from concussion/mild traumatic brain injury (mTBI).Data were collected from standardized questionnaires, neuroimaging records, and comprehensive clinical assessments. Bivariate associations were calculated using the Spearman correlation coefficient or analysis of variance. We established sex-specific stepwise multivariate linear regression models of factors associated with pain.Of the 94 participants diagnosed with mTBI (the mean age was 45.20 ± 9.94 years; 61.2% were males; the median time since injury was 197 days [interquartile range 139-416]), head/neck, and bodily pain were reported by 93% and 64%, respectively. No sex differences were identified in pain frequencies or severity. Pain was significantly associated with certain socio-demographic, injury-related, behavioral, and clinical variables. In the multivariable regression analysis, several determinants explained 60% of the pain variance in males and 46% in females.Pain is common in patients with delayed recovery from mTBI and is significantly associated with potentially modifiable clinical and nonclinical variables. Examining the multidimensional construct of pain in concussion/mTBI through a sex lens garners new directions for future longitudinal research on the pain mechanisms involved in postconcussion syndrome.

Conflict of interest statement

The remaining authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Multidimensional construct of pain in traumatic brain injury. Modified from Price (1999), Brennan, Carr, and Cousins (2007), and Guindon and Hohmann (2009). Unidirectional arrows between constructs (ie, rectangles) and items (ie, ovals) represent reflective models, and from items to constructs, formative models.
Figure 2
Figure 2
Flow chart depicting process of selection of participating individuals’ data for analysis. TBT = traumatic brain injury.
Figure 3
Figure 3
Flow diagram depicting the stepwise multiple regression analysis of pain in males and females combined. ∗Each model age- and sex-adjusted. DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders 4th edition, HADS-A = Hospital Anxiety and Depression Scale-Anxiety Subscale, PHQ-9 = Patient Health Questionnaire-9, SSRI = selective serotonin reuptake inhibitor, TCA = tricyclic antidepressant.
Figure 4
Figure 4
Flow diagram depicting the stepwise multiple regression analysis of pain in males. ∗Each model age-adjusted. DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders 4th edition, PHQ-9 = Patient Health Questionnaire-9, SSRI = selective serotonin reuptake inhibitor.
Figure 5
Figure 5
Flow diagram depicting the stepwise multiple regression analysis of pain in females. ∗Each model age-adjusted, ∗∗included due to consistently reported associations. DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders 4th edition, PHQ-9 = Patient Health Questionnaire-9, SSRI = selective serotonin reuptake inhibitor.

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