A PROTOCOL FOR MANAGING PAIN, SLEEP DISORDERS, AND ASSOCIATED PSYCHOLOGICAL SEQUELAE OF PRESUMED MILD HEAD-INJURY

The coincidence of mild head injury and chronic pain is quite high. In bet, there appears to be an Inverse relationship between the severity of head injury and the incidence of pain complaints. Many of the presenting problems, which in the past have been thought to be due to cerebral causes only or perhaps to vaguely defined psychological or psychosocial factors, may be more appropriately viewed as part of a constellation of factors, including myofascial pain, sleep disorders, psychological factors, and iatrogenic harm. A treatment protocol is presented that outlines a sequential approach that has been found to be helpful with patients who have a history of head injury and chronic pain complaints. Two case studies are presented that illustrate the issues described above and the importance of concurrent treatment of myofascial pain, sleep disorders, and psychological dysfunction to prevent excess disability in this patient population.