The relationship of psychological and cognitive factors and opioids in the development of the postconcussion syndrome in general trauma patients with mild traumatic brain injury

Abstract

The relationship of psychological and cognitive factors in the development of the postconcussion syndrome (PCS) following mild uncomplicated traumatic brain injury (mTBI) has received little study. This may be because of the widely held belief that neurological factors are the cause of early PCS symptoms, whereas psychological factors are responsible for enduring symptoms. To further understand these relationships, the association between PCS and neuropsychological and psychological outcome was investigated in 122 general trauma patients, many of whom had orthopedic injuries, around 5 days following mTBI. Apart from verbal fluency, participants with a PCS did not differ in their performances on neuropsychological measures compared to those without a PCS. Individuals with a PCS reported significantly more psychological symptoms. Large effect sizes present on the psychological measures showed that the difference between participants with a PCS and without was greater on psychological than on neuropsychological measures. Analyses also revealed a relationship between opioid analgesia and depression, anxiety and stress, and opioids and reduced learning. The results suggest that psychological factors are present much earlier than has previously been considered in the development of the PCS.

Enhanced vocational rehabilitation for Veterans with mild traumatic brain injury and mental illness: Pilot study

“…The comorbid occurrence of mTBI and MI is high among the Veteran population [8][9][10][11]. Mental health diagnoses in these populations often better account for lingering cognitive symptoms than the mTBI itself [12][13], consistent with the civilian literature on mTBI [14][15][16][17][18]. In fact, in a sample of more than 4,000 Army Veterans with a psychiatric diagnosis, such as depression, generalized anxiety disorder, or posttraumatic stress disorder (PTSD) and no history of mTBI, the incidence of postconcussive syndrome symptoms, including cognitive difficulties, was greater than it was for Veterans with a history of mTBI [19].…”

A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the “post-inflammatory brain syndrome” PIBS

“…As mentioned earlier, Meares et al (2006) state that PCS is more common in patients with a pre-existing psychiatric disorder and this phenomenon maybe explained by the sensitisation theory described by Robson (2003). Robson used the sensitisation theory to explain the under performance of endurance athletes.…”

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

“…What is particularly important about pain, regardless of its source, is that pain changes the functioning of the brain, demonstrated by both structural as well as functional imaging (Schweinhardt et al, 2006). Also, the nature and extent of early medication treatment in those who sustain mTBI, may also relate to who develops PPCS (Meares et al, 2006).…”

“…In fact, one of the most cited publications in the clinical literature on concussion is that of Miller (1961) whose series of articles centered on the theme of concussion being nothing more than "Accident Neurosis", which others have labeled as "Compensation Neurosis" (Levy, 1992) because of the prevalence of lawsuits involving mild head injury (Hall & Chapman, 2005;Mooney et al, 2005). No doubt "psychological" factors play an important role in the residuals from concussion (Meares et al, 2006;Whittaker et al, 2007;Wood, 2007), but they and other "functional" factors are also the source of intense debate and controversy over the existence of post-concussive symptomology (Cantu, 2007;Evans, 1994;King, 2003). These controversies will be discussed in greater detail later in this review.…”