Pain and chronic mild traumatic brain injury in the US military population: a Chronic Effects of Neurotrauma Consortium study

Hoot, Michelle R.; Levin, Harvey S.; Smith, Austin; Goldberg, Gary; Wilde, Elisabeth A.; Walker, William C.; Eapen, Blessen C.; Nolen, Tracy L.; Pugh, Norma

doi:10.1080/02699052.2018.1482427

Cited by 21 publications

(10 citation statements)

References 34 publications

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“…Many prior cross‐sectional studies have shown that sleep is correlated with post‐concussive outcomes including: cognitive function, depression, anxiety, PTSD, return to play and school, and return to work at various time points . However, the purpose of this systematic review was to expand beyond the previously conducted cross‐sectional studies to examine the association between sleep during the acute stage of a concussion and longer‐term post‐concussive outcomes.…”

Section: Discussionmentioning

confidence: 99%

Sleep Disturbances in the Acute Stage of Concussion are Associated With Poorer Long‐Term Recovery: A Systematic Review

Ludwig

D’Silva

Vaduvathiriyan

et al. 2020

PM&R

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Objective: To examine the association between sleep during the acute stage of concussion and long-term outcomes. Literature Survey: Literature searches were performed 1 July 2018 to 1 August 2018 in Ovid MEDLINE, CINAHL, and Web of Science, along with hand searching for gray literature and cited references. Of the 610 search results, 359 unique references were reviewed after duplicates were removed. Methodology: Two reviewers independently reviewed and came to consensus on which titles/abstracts met inclusion/exclusion criteria (n = 23). The 23 full-text articles were assessed independently by the same two reviewers for eligibility. Consensus was achieved, leaving four articles for quality assessment and data extraction. One person extracted relevant data from each study using a standard data-extraction table. The data extraction table was reviewed by two reviewers and consensus was achieved for completeness and accuracy. Quality appraisal was conducted to assess the risk for potential bias and quality of included articles. Synthesis: Two of the articles included children younger than 16 years old and two included a wide age range. In general, poorer sleep was associated with poorer outcomes following concussion at reassessments across any age population. In addition, poorer sleep in the acute stage of concussion was associated with poorer long-term outcomes and recovery. Conclusions: The variability in sleep assessments used, symptoms assessed, length of time to reassessments, and comparator group included made data synthesis challenging. The use of standard valid and reliable sleep assessments is recommended. Future studies may consider if addressing sleep disturbances early following concussion will improve longer-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Sleep Disturbances in the Acute Stage of Concussion are Associated With Poorer Long‐Term Recovery: A Systematic Review

Ludwig

D’Silva

Vaduvathiriyan

et al. 2020

PM&R

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“…For example, the presence of comorbidities in the mTBI group may have influence on the findings in the present study. Future investigation into the effects of comorbid chronic pain, posttraumatic stress disorder, and depression, which are more common in mTBI than that observed in orthopedic control participants (44, 45), on fatigue and effort is warranted. Another common comorbid condition in mTBI is sleep disturbance, which was not assessed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Effort and Fatigue-Related Functional Connectivity in Mild Traumatic Brain Injury

et al. 2019

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Mental fatigue in healthy individuals is typically observed under conditions of high cognitive demand, particularly when effort is required to perform a task for a long period of time—thus the concepts of fatigue and effort are closely related. In brain injured individuals, mental fatigue can be a persistent and debilitating symptom. Presence of fatigue after brain injury is prognostic for return to work/school and engagement in activities of daily life. As such, it should be a high priority for treatment in this population, but because there is little understanding of its behavioral and neural underpinnings, the target for such treatment is unknown. Here, the neural underpinnings of fatigue and effort are investigated in active duty military service members with mild traumatic brain injury (mTBI) and demographically-matched orthopedic controls. Participants performed a Constant Effort task for which they were to hold a pre-defined effort level constant for long durations during fMRI scanning. The task allowed for investigation of the neural systems underlying fatigue and their relationship with sense of effort. While brain activation associated with effort and fatigue did not differentiate the mTBI and controls, functional connectivity amongst active brain regions did. The mTBI group demonstrated immediate hyper-connectivity that increased with effort level but diminished quickly when there was a need to maintain effort. Controls, in contrast, demonstrated a similar pattern of hyper-connectivity, but only when maintaining effort over time. Connectivity, particularly between the left anterior insula, rostral anterior cingulate cortex, and right-sided inferior frontal regions, correlated with effort-level and state fatigue in mTBI participants. These connections also correlated with effort level in the Control group, but only the connection between the left insula and superior medial frontal gyrus correlated with fatigue, suggesting a differing pattern of connectivity. These findings align, in part, with the dopamine imbalance, and neural efficiency hypotheses that pose key roles for medial frontal connections with insular or striatal regions in motivating or optimizing performance. Sense of effort and fatigue are closely related. As people fatigue, sense of effort increases systematically. The data propose a complex link between sense of effort, fatigue, and mTBI that is centered in what may be an inefficient neural system due to brain trauma that warrants further investigation.

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“…Sleep disturbance following TBI is receiving increasing attention as both an effect of injury34 35 and mediator of poor recovery 34 36. Sleep disturbance is one of the most commonly cited residual effects among people who have persistent symptoms from mild TBI 37. Sleep disturbance has been implicated as a source of chronic inflammation,38 which may mediate neuroinflammatory processes due to TBI 31 32.…”

Section: Discussionmentioning

confidence: 99%

Current health status and history of traumatic brain injury among Ohio adults

et al. 2019

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IntroductionLifetime history of traumatic brain injury (TBI) with loss of consciousness (LOC) is prevalent in 21% of adult, non-institutionalised residents of Ohio. Prior history has been associated with lower incomes, inability to work and disability. The current study sought to evaluate the relationship between lifetime history and adverse health conditions.MethodsData came from the 2014 Ohio Behavioral Risk Factors Surveillance System, which included a state-specific module eliciting lifetime history of TBI.ResultsNon-institutionalised adults living in Ohio who have had at least one TBI with LOC were more likely to report fair or poor health, more days of poor health, more days when poor health limited activities, being diagnosed with a chronic condition and having less than 7 hours of sleep per night. The relationship with increasing number of TBIs was monotonic, with the likelihood of adverse health increasing as the number increased. A similar relationship was observed for increasing severity of the worst lifetime TBI. Experiencing a first TBI before age 15 was associated with poorer health but was not statistically different than incurring a first after age 15.ConclusionsAdults who have experienced TBI with LOC in their lifetime are two to three times more likely to experience adverse health conditions when compared with same age-matched, sex-matched and race-matched adults without such history. These findings support re-examining the public health burden of TBI in light of lifetime exposure and not just the consequences of an index injury.

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Pain and chronic mild traumatic brain injury in the US military population: a Chronic Effects of Neurotrauma Consortium study

Abstract: mTBI is strongly associated with pain intensity and pain interference in this sample. However, the effect appears to be mediated by other common mTBI comorbidities: PTSD, depression, anxiety and sleep disturbance.

Cited by 21 publications

References 34 publications

Sleep Disturbances in the Acute Stage of Concussion are Associated With Poorer Long‐Term Recovery: A Systematic Review

Sleep Disturbances in the Acute Stage of Concussion are Associated With Poorer Long‐Term Recovery: A Systematic Review

Effort and Fatigue-Related Functional Connectivity in Mild Traumatic Brain Injury

Current health status and history of traumatic brain injury among Ohio adults

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