Post-Concussion Syndrome (PCS) has been identified as causing debilitating symptoms in some people with mild traumatic brain injury. These symptoms include emotional changes, cognitive dysfunction, as well as physical pain.

The problem is that many of the symptoms of PCS are the same as those experienced by patients with chronic pain. The challenge is to determine the actual origin of the symptoms so that proper treatment can be implemented.

This current study’s goal was to carefully examine the symptoms reported by both brain injured patients and those individuals with chronic pain.

The study was composed of 63 patients with chronic pain (CP) and no history of neurological problems, and 32 patients with mild traumatic brain injury (MTBI). The CP patients came mainly from a multidisciplinary CP treatment program at a local rehab hospital (78%) and from the authors’ private practices. Any patients with a history of head injury were excluded from this group. The MTBI patients came from outpatient evaluations at a local teaching hospital (41%) and the authors’ private practices (59%). Patients with pain from injuries other than MTBI were excluded from this second group.

One factor that made differentiating the two groups difficult is that most of the MTBI patients complained of pain (27 out of the 32); in fact, pain is often associated with seeking treatment in MTBI. They most frequently reported headaches, but also reported other symptoms.

Both groups were administered the Rivermead Post Concussion Questionnaire, a 16-item questionnaire that relies on self-reporting of symptoms based on their severity, and how the patient perceived their functioning prior to injury.

The questionnaire evaluated:

  • Somatic symptoms: headache, dizziness, nausea, noise sensitivity, sleep disturbance, fatigue, light sensitivity, and double vision.
  • Emotional symptoms: irritability, depression, frustration, impatience, restlessness
  • Cognitive symptoms: memory problems, concentration problems, taking longer to think.
Study Results

While the total scores on the Rivermead questionnaire were slightly higher for the MTBI group, their overall scores did not differ significantly from those for patients with CP overall.

The MTBI group did have more cognitive symptoms, while those with CP demonstrated more emotional symptoms when tested. However, a significant percentage of the patients with CP stated they had symptoms typically associated with MTBI. For instance, 67% of the CP group noted problems with memory, and 78% noted difficulty with concentration since their injury.  From these findings, it is clear that it is not possible to accurately diagnose MTBI based on cognitive symptoms alone.

Percent Reporting Symptom

 Symptom

Brain Injured

Chronic Pain

Headaches

81

71

Dizziness

56

40

Nausea

31

43

Noise sensitivity

69

42

Sleep disturbance

72

97

Fatigue

81

90

Irritability

78

86

Depression

63

84

Frustration/impatience

81

89

Memory problems

94

67

Concentration problems

94

78

Taking longer to think

94

71

Blurred vision

47

32

Light sensitivity

65

30

Double vision

28

11

Restlessness

63

87

After all the data was analyzed, there were some trends that could be useful in detecting the presence of chronic pain in some patients. Chronic pain patients were more likely to:

  • Report nausea
  • Complain of sleep disturbances
  • Report fatigue and irritability
  • Report symptoms of depression
  • Complain of restlessness

The percentage of patients in the two groups meeting the criteria for post-concussion syndrome was very similar:  81.3% of the MTBI patients, and 82.5% of the patients with CP, so there is obviously a large overlap in symptoms reported by both groups of patients.

Chronic pain and brain injury are both serious conditions that require different treatment regimens. If either condition is misdiagnosed, this will delay the proper treatment and result in even more problems down the road. These patients should be referred as soon as possible for a correct diagnosis.

Smith-Seemiller L, Fow NR, Kant R, Franzen MD. Presence of post-concussion syndrome symptoms in patients with chronic pain vs mild traumatic brain injury. Brain Injury 2003;17(3):199-206.