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Meta-Analysis
. 2009 Oct;10(7):1200-17.
doi: 10.1111/j.1526-4637.2009.00721.x.

Systematic review of the literature on pain in patients with polytrauma including traumatic brain injury

Steven K Dobscha  1 , Michael E Clark, Benjamin J Morasco, Michele Freeman, Rose Campbell, Mark Helfand
Affiliations
Meta-Analysis

Systematic review of the literature on pain in patients with polytrauma including traumatic brain injury

Steven K Dobscha et al. Pain Med. 2009 Oct.

Abstract

Objective: To review the literature addressing the assessment and management of pain in patients with polytraumatic injuries including traumatic brain injury (TBI) and blast-related headache, and to identify patient, clinician and systems factors associated with pain-related outcomes.

Design: Systematic review.

Methods: We conducted searches in MEDLINE of literature published from 1950 through July 2008. Due to a limited number of studies using controls or comparators, we included observational and rigorous qualitative studies. We systematically rated the quality of systematic reviews, cohort, and case-control design studies.

Results: One systematic review, 93 observational studies, and one qualitative research study met inclusion criteria. The literature search yielded no published studies that assessed measures of pain intensity or pain-related functional interference among patients with cognitive deficits due to TBI, that compared patients with blast-related headache with patients with other types of headache, or that assessed treatments for blast-related headache pain. Studies on the association between TBI severity and pain reported mixed findings. There was limited evidence that the following factors are associated with pain among TBI patients: severity, location, and multiplicity of injuries; insomnia; fatigue; depression; and post-traumatic stress disorder.

Conclusions: Very little evidence is currently available to guide pain assessment and treatment approaches in patients with polytrauma. Further research employing systematic observational as well as controlled intervention designs is clearly indicated.

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Figures

Figure 1
Figure 1. Analytic framework
Figure 2
Figure 2. Management of pain in polytrauma literature flow
See this image and copyright information in PMC

References

    1. Lew HL, Poole JH, Vanderploeg RD, et al. Program development and defining characteristics of returning military in a VA Polytrauma Network site. J Rehabil Res Dev. 2007;44:1027–34. - PubMed
    1. Gawande A. Casualties of war—military care for the wounded from Iraq and Afghanistan. N Engl J Med. 2004;351:2471–5. - PubMed
    1. Friedemann-Sanchez G, Sayer NA, Pickett T. Provider perspectives on rehabilitation of patients with polytrauma. Arch Phys Med Rehabil. 2008;89:171–78. - PubMed
    1. Warden D. Military TBI during the Iraq and Afghanistan wars. J Head Trauma Rehabil. 2006;21:398–402. - PubMed
    1. Fischer H. United States military casualty statistics: Operation Iraqi freedom and operation enduring Freedom (RS22452) Washington, DC: Congressional Research Service; 2009.

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