WHEN PAIN CONTROL HURTS [ back to What's New ]
Chronic pain often follows a TBI, in the form of migraines, spinal pain from disc herniations or myofascial pain disorder involving inflammation and fibrous scarring of muscle tissue. Such pain must be brought under control, because pain and its sequelae (depression, insomnia and fatigue) distract survivors from concentrating on rehab tasks such as cognitive, speech or physical therapy. However, not all pain remedies are created equal, and some have the potential to cause new injuries or problems. Overuse of narcotic analgesics like Vicodin or Codeine can create addiction and dull cognition. Rebound headache can result from overuse of OTC (over-the-counter) migraine pills such as Excedrin Migraine. In the Oct. 1999 issue of Headache, Excedrin Migraine maker Bristol-Myers conceded that daily use of its pill was likely to increase the frequency of migraine, and should not be taken more than 2-3 times per week.  Overuse of Excedrin, Anacin, Tylenol and Advil have  all been associated with  "rebound headache." Why does rebound headache occur? There are several theories: withdrawal symptoms from addiction to caffeine in these pills; build-up of a "false tolerance" to pain accompanied by an extreme response to slight pain; or growth of extra pain receptors in response to chronic blockade of pain by these pills. So far, the clinical solution to rebound headache is to wean the user off the particular pill being overused, and then start him on a alternating combo of new medications. Another pain control technique that can backfire is acupuncture. In the hands of unskilled practitioners acupuncture needles can puncture and deflate the lungs or fracture ribs. Chiropractors who use high force adjustments to the upper neck can cause stroke or paralysis. There is a new neurosurgical procedure aimed at fibromyalgia patients which allegedly cures headache and depression by sawing bone away from the base of the skull to reduce "pressure" on the brain. This procedure poses many risks including brain damage, infection and reducing skull protection against future trauma. While effective pain control is a vital component of recovering from a TBI, attention must be paid to the efficacy, safety and potential complications of using a given technique or using the services a particular practitioner. One way of exercising caution is to consult a licensed physician who is Board Certified in rehabilitation medicine (physiatry) or in pain medicine.