Evaluating assessment methods for pain in persons with traumatic brain injury

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Dr. Elizabeth Felix
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Recent estimates suggest that at least 50% of persons with TBI develop a chronic pain problem after their injury, including central pain, which is notoriously hard to treat. Although it is acknowledged by the healthcare community that the assessment and treatment of pain is crucial for improving quality of life across all patient populations, it may be difficult to adequately evaluate pain in persons with cognitive impairments, such as those with TBIs. We are conducting a pilot investigation of the reliability and validity of four commonly-used rating scales for pain intensity in persons with cognitive impairment after TBI. Approximately 30 participants will complete the study. Subjects are assessed with regards to cognitive function, including measures of attention, processing speed, memory, and executive function, and asked to rate the pain produced by different levels of brief thermal stimuli presented to their forearm, using the numerical rating scale, the visual analogue scale, the verbal rating scale, and the faces pain scale. Results from this pilot study will serve to help in the development of methods and hypotheses for a future, larger study aimed at introducing evidence-based guidelines for pain assessment in this patient population.