TBI and Chronic Pain: Part 2 (Text Alternative

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Infocomic Main Characters

Mother: A middle-aged Asian American female. She has black, chin-length hair.

Son: A teenage Asian American male. He has dark, straight hair with bangs.

Daughter: A grade-school aged Asian American female. She has dark, straight, shoulder-length hair.

Husband: A middle-aged White male. He has short, curly black hair.

Physical therapist: A young White male. He has short, swept back hair.

Infocomic Story Description

A mother reflects on the car crash that led to her TBI.

“The other driver wasn’t paying attention... thankfully my son wasn’t hurt, but my airbag discharged when the other driver hit my door. The next thing I remember is waking up in the hospital with a TBI and a broken hip.”

She leaves the hospital in a wheelchair. “Since my TBI, I get tired so quickly, and when I’m tired, my hip pain is worse.”

At home, her family greets her with banners and a cake.

“It was great to be home. But at the same time, I wanted to work as hard as I could to get back to how I was before my injury.”

The mother is at the park with her daughter when her hip pain flares. Pain from multiple injuries can be hard to treat because the symptoms may add to each other.

She stands outside her car. She realizes she locked her keys inside. “When I’m in pain, my memory is worse, it’s harder to process information, and I have trouble staying focused. Pain even does that to people without TBI.”

She sits up in bed. Her clock shows it is 2:37 a.m. “My pain makes sleeping difficult.”

She rides in the passenger seat of a car. She says, “This traffic is terrible. I just want to go home!”

“I was always tired and stressed, which made my pain worse. It was a downward spiral.”

PTSD

People who go through traumatic events can have post-traumatic stress disorder (PTSD). People with PTSD may feel stressed or afraid even when they are not in danger. Some people with PTSD will have flashbacks, where they “re-experience” the event. PTSD can make people want to avoid things that remind them of the trauma. They may also startle easily or have changes in their moods. Both pain and PTSD can lead people to avoid places or activities. This can be limiting and result in isolation, which can make pain and PTSD worse.

The mother is in the passenger seat of a car once more. Another driver is leaning on their horn, causing her obvious distress. “When I’m tired or in pain... or both, it makes my anxiety worse, and that feeds into my PTSD. I didn’t know how to break the cycle, so I talked to my physical therapist about how to deal with pain.”

The mother sits in a room with her physical therapist. She says, “I end up overdoing it and then I can’t do anything for the next couple days.” He responds, “It sounds like you have a ‘pain-activity-cycle.’ I want to replace that with a ‘rest-activity-cycle’.”

The mother and her physical therapist are in a long hallway. The mother walks with a cane. He notes, “Walking is something that causes pain for you. So, I’d like you to walk laps in this hall. I’m going to time how long it takes before the pain starts.” She exclaims, “OK, got it!”

With a pain-activity cycle, pain drives activity. A person works as much or as hard as they can until pain makes them unable to continue. Then they can’t do anything until they recover. This often leads to their abilities decreasing over time.

With a rest-activity cycle, a person stops activity before pain develops. They gradually increase activity with periods of rest between activities. This practice can build endurance and abilities with minimal levels of pain.

As the mother rests in a chair, the physical therapist leans toward her while looking at a stopwatch. He notes, “OK, your pain started after 35 minutes of walking. Keep walking every day but remember this feeling. It’s your reminder to rest. You will build endurance with regular activity.”

The mother is at the park with her daughter. She is reviewing an activity log she printed off. “I used an activity log to track and gradually increase my activity. By learning to stop before I was in pain, I was able to increase my activity a little every day.”

“That helped me to gain more endurance. I still have pain, but I have less flare ups and they’re not as bad as when I was ignoring my limits.”

The mother calls to her daughter, “Time to go!” They drive away in the car. “My PTSD didn’t go away but it became less of a problem after I got more control over my pain.”

Activity Log

You can use this log to track activities or events that may be related to pain. This log can also be used to record your pain management practice.

Date/Time
What was happening? (Event or activity)
For how long/When?
Did you have pain? (0-10)(Where?)
Other Emotions?
What thoughts did you have?
What did you do in response?

Source

The content in this infocomic is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model Systems (TBIMS), funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), as well as experts from the Polytrauma Rehabilitation Centers (PRCs), with funding from the U.S. Department of Veterans Affairs. This infocomic was written by Silas James and Ayla Jacob and illustrated by David Lasky and Tom Dougherty, in collaboration with the Model Systems Knowledge Translation Center. This infocomic is adapted from the factsheet series Chronic Pain After Traumatic Brain Injury (https://msktc.org/tbi/factsheets/traumatic-brain-injury-and-chronic-pain) developed by Silas James, MPA; Jeanne Hoffman, PhD; Sylvia Lucas, MD, PhD; Anne Moessner, APRN; Kathleen Bell, MD; William Walker, MD; CJ Plummer, MD; Max Hurwitz, DO, in collaboration with the Model Systems Knowledge Translation Center.

Disclaimer

This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. The contents of this infocomic were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90DP0031 and 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this infocomic do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.

Copyright © 2021 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.