Excerpt

Polytrauma is defined in the VHA Polytrauma Rehabilitation Centers Directive dated June 8, 2005 as: “injury to the brain in addition to other body parts or systems resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability.” The definition of polytrauma has since expanded to include concurrent injury to two or more body parts or systems that results in cognitive, physical, psychological or other psychosocial impairments. Traumatic Brain Injury (TBI) often occurs in polytrauma and in combination with other disabling conditions including amputation, auditory or visual impairments, spinal cord injury (SCI), post-traumatic stress disorder (PTSD), and other mental health conditions.

Pain resulting from polytraumatic injuries poses numerous challenges during rehabilitation treatment and afterwards. Treatments typically used to reduce pain in these individuals (for example, oral opioids) have the potential to interfere with the active rehabilitation needed to restore function.

The objectives of this report are to systematically review the literature to address the assessment and management of pain in patients with polytraumatic injuries, to identify patient, clinician and systems factors associated with pain-related outcomes in these patients, and to describe current or planned research addressing the key questions.

Contents

• PREFACE
• EXECUTIVE SUMMARY
• INTRODUCTION
  • Background
• METHODS
  • Topic Development
  • Literature Search Strategy
  • Study Selection
  • Data Abstraction
  • Quality Assessment
  • Data Synthesis
  • Rating the body of evidence
  • Active Research
  • PEER REVIEW
• RESULTS
  • Literature Flow
  • Key Question #1. Have reliable and valid measures and assessment tools been developed to measure pain intensity and pain-related functional interference among patients with cognitive deficits due to traumatic brain injury (TBI)? Which measures and tools are likely to be most useful in assessing pain in polytrauma patients with cognitive deficits due to TBI?
  • Key Question #2.A. Which treatment approaches are most likely to be effective in improving pain outcomes (pain intensity and functional interference) in polytrauma patients? B. Which pain treatment approaches are most likely to enhance overall rehabilitation efforts?
  • Key Question #3.A. Does blast-related headache pain differ in terms of phenomenology and treatment from other types of headache pain? B. Which treatments are best for persistent blast-related headache pain?
  • Key Question #4. What patient factors are associated with better and worse (pain-related) clinical outcomes among polytrauma patients? Have interventions been developed to specifically address these factors?
  • Key Question #5. What are unique provider and system barriers to detecting and treating pain among polytrauma patients? Have interventions been developed to effectively address these barriers?
  • Limitations—Literature Review
  • RESULTS—ACTIVE RESEARCH
  • Limitations—Active Research
• SUMMARY AND DISCUSSION
• CONCLUSIONS
• FUTURE RESEARCH RECOMMENDATIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGY
• APPENDIX B ARTICLE SCREENING FORM
• APPENDIX C USPSTF QUALITY RATING CRITERIA
• APPENDIX D REVIEWER COMMENTS AND RESPONSES
• APPENDIX E EVIDENCE TABLES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Portland Veterans Affairs Healthcare System, Oregon Evidence-based Practice Center, Portland, OR.