Return to graphic version of TBI and Chronic Pain: Part 1 Infocomic

Infocomic Main Characters

Max: A middle-aged White male. He has full, dark hair and a long dark beard and is wearing a T-shirt. 

Mohammed (Mo): A middle-aged male of Middle Eastern descent. He has straight, dark hair and is clean-shaven. He wears a soccer jersey at the meeting and a buttoned-up shirt and apron at work.

Chef: An adult African American male. He has short, dark hair and is clean-shaven and wears a T-shirt. He works in the kitchen at Mo’s work. 

Peer: An adult Latina female. She has dark, chin-length hair with bangs and wears a black top.

Infocomic Story Description

Max is attending a chronic pain management support group. He is excited to see a table with free doughnuts. Mohammed, the support group leader, calls out, “Hi! Are you here for the TBI support group?”

Max takes a doughnut and responds, “I don’t know…I have a TBI and pain, but I don’t know if it’s chronic.”

Mohammed explains, “Pain is chronic when you’ve had it for more than 3 months.”

Max admits, “Well, then, yes, I have chronic pain. My name is Max, by the way.”

Mohammed says, “Hi, Max, I’m Mohammed! I started this group to build a supportive community.”

Common reasons for pain after TBI

HEADACHE

Most people with TBI have headaches at some point after their injury. For many people, headaches start right after their TBI. But for some people, they can start weeks, or even months, after their injury. There are several types of headaches. To learn more, refer to the infocomic “TBI and Headaches.”

NEUROLOGICAL OR NERVE PAIN

The brain and central nervous system process pain signals. Tissue damage or injury usually are the cause of these signals. When a nerve gets injured, it can cause different pain than the pain you may feel after damage to other types of tissue. Nerve pain can feel electric or like burning. It may feel hot or cold. It may even feel like numbness or tingling in your arms or legs. Health care providers often treat these types of pain with special prescription medications. Chemical changes in the brain can also cause pain without obvious damage or injury.

MUSCLE OR BONE PAIN AND CO-OCCURRING INJURY

When a TBI happens, you may also hurt other parts of your body. For example, you may have a fracture, a disc injury, or torn ligaments. The pain from multiple injuries can be harder to treat because the symptoms may add to each other.

As they approach the table in the meeting room, Mohammed explains, “Pain itself is very personal. Everyone here has different types of pain. For some, their pain is tolerable. But for others, the same pain would affect their ability to function.”

Finding What Works

People use many different strategies to manage their pain. Examples include:

  • Exercise
  • Cognitive behavioral therapy (CBT)
  • Scheduled rests or pacing meditation
  • Biofeedback
  • Breathing exercises
  • Visualization hypnosis
  • Art therapy
  • Acupuncture
  • Massage
  • Heat or ice
  • Social activity

Mohammed says to the group, “There are many different causes of pain and even more ways for people to manage it.”

Pain can take many forms:

  • Hot or like burning
  • Sharp like a needle prick or bee sting
  • Throbbing that shift between more and less severe
  • Tingling like a foot that has fallen asleep
  • A dull ache that may hurt worse with movement
  • Numbness or decreased feeling

While Mohammed dunks a doughnut in his coffee, he says, “What works for me may not work for you. Don’t get discouraged if you have to try a few different things. Like most people, my headaches began right after my TBI. But they can start weeks, or even months, after an injury. I used an activity log and learned that my headaches are caused mainly by fatigue.”

Mohammed then reflects on his job as a waiter at a restaurant, “Even if I’m having a good day, if I don’t pace myself, things can go downhill really quick.”

The chef at his work welcomes him, “How’s it going, Mo?”

In his memory, Mohammed goes through his workday with more visible signs that he’s getting a headache. “Sometimes I don’t realize I’m getting a headache until it’s too bad to ignore. When I have a headache, it’s hard to focus or even think about anything but my pain.”

The chef comes to his side. “Hey, Mo, are you ok? Why don’t you take off early tonight?”

Mo admits, “Once I’m in pain, I can’t function.”

There are many strategies for managing pain.

On-Demand Pain Management Strategy #1

MINDFULNESS: Acknowledge your pain and examine it as you would something you have just discovered. Study how it feels. Observe the emotions you have in response to it and how your body reacts to those sensations and emotions. Then direct your attention to the sounds around you. After you’ve examined those, repeat these steps with your other senses (sight, smell, touch).

Mohammed is sleeping on his couch, next to his dog. He admits, “It took a long time to realize, but I need to pace myself. Because my job isn’t very flexible, and I’m a single dad, I adjusted other parts of my life to conserve energy.” Sometimes this may mean taking time to enjoy a coffee in a comfy chair.

Managing Your Activity

PACING is taking breaks during the day, or during an activity. This allows you to do more overtime. Pay attention to how your body feels during and after activities. This will help you shift from stopping something after you’re in pain, to pausing before you feel pain. Pacing helps you do the things that are important to you while still conserving your energy. Learning how to pace yourself takes practice.

DELEGATING is finding ways to have other people do things. This helps you to save energy, which is likely to help with pain.

  • Use a grocery service or app instead of going to the store yourself.
  • Ask your partner to carry the laundry to the machine. Then, you can wash, dry, and fold it.

ADJUSTING is finding ways to do things that might be draining or time consuming. This can also help to lessen pain.

  • Instead of cooking every night, you could use a slow cooker to make several meals at once.
  • Lay your clothes out before you go to bed to save time in the morning.

Mohammed goes on to explain, “I started ‘delegating’ some things I would normally do myself. For example: my mom takes my sons to school on the days I work. I ‘adjusted’ other activities. Instead of cooking dinner every night, I use a slow cooker to make meals ahead of time.”

Mohammed is seen talking to his support group again. “I made a lot of little changes, but it made a big difference in my life. But I know we all have different experiences. Anyone else want to share?”

His peer speaks up. “Yes, I have something I can share,” she says.

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.