Untangling chronic pain and post-concussion symptoms: the significance of depression

Objectives: Post-concussion-like symptoms (PCS) are common in patients without a history of brain injury, such as those with chronic pain (CP). This exploratory study examined neuro-cognitive and psychological functioning in patients with PCS following mild traumatic brain injury (mTBI) or CP, to assess unique and overlapping phenomenology.Methods: In this case-control study, participants (n=102) with chronic symptoms after mTBI (n=45) were matched with mTBI recovered (n=31) and CP groups (n=26), on age, gender, ethnicity and education. Psychological status, cognitive functioning, health symptoms, beliefs and behaviours were examined.Results: Participants who had not recovered from an mTBI and participants with CP did not differ in terms of PCS symptoms, quality of life, distress or illness behaviours, however, the CP group endorsed fewer subjective cognitive problems, more negative expectations about recovery and more distress (p<0.05). On cognitive testing participants who had not recovered from an mTBI demonstrated greater difficulties with attention (p<0.01) although differences disappeared when depression was controlled in the analyses.Conclusions: Unique patterns associated with each condition were evident though caution is required in attributing PCS and cognitive symptoms to a brain injury in people with mTBI presenting with chronic pain and/or depression. Psychological constructs such as illness and recovery beliefs appear to be important to consider in the development of treatment interventions.