Pain management post head injury

[edinburghpartner]

Hi,

My partner had a traumatic brain injury in 1992, and for their entire life they've been very sensitive to pain.

They broke their ankle last week, and have been in excruciating pain no matter what painkillers they take or how often.

From what I can tell, although it's difficult to find information, it looks like painkillers may not be effective for people with brain injuries.

I am looking for a couple of things:

1) are there any resources confirming that this is the case, because googling pain management with brain injury brings up results about pain specifically caused by the injury. I'm hoping to have something to show GPs or other medical personnel if something happens again.

2) does anyone have any tips on how to manage pain when painkillers don't work? I am asking this both for the current broken ankle and for recurring extremely painful periods which result in several days of not being able to do much more than get out of bed to sit on the sofa (this sounds harsh, but my primary concern re not doing anything other than that is about their mental health).

Any help would be much appreciated.

[Marnie22]

Hi. I think the Headway helpline might be good to contact. Their number is 0808 800 2244. They have a surprisingly wide range of information and advice.

Wishing all the best. 🙂🌸

[bridgeit]

What an awful experience for your hubby and for you trying to find some help.

Being no medic, I can only offer a few ideas and suggestions.

It sounds from what you're saying that it's your hubby's pain pathway wiring that's gone awry, so the usual painkillers, including strong opioids, might well not 'block' the usual pain signals. If you're in the mood for a Google search, try looking up "allodynia" and associated treatments if you haven't already.

I know that for neuralgic pain, the recommendation tends to be a tricyclic antidepressant called Amitriptyline, which is reckoned to be good and certainly did work to help my migraine, but I had to stop when it worsened my tinnitus. A friend who had fibromyalgia also found this drug a boon. Worth a shot if not tried already? I was told by a neurologist that 10mg daily is about right to begin with; can go up to 150mg daily, though that's usually for depression. An alternative might be pregabalin. Either way, a GP is best placed to advise.

Off the wall suggestions: acupuncture (Chinese style with needles), hypnosis and Chinese traditional herbalist. One word of caution; don't ingest anything herbal without first checking contra-indications with existing medication with a good pharmacist. They should check it out for you (mine did). Some of the genuine Chinese herb remedies are really potent.

I hope you and your husband soon find something that works, even partway.

[sospan]

Hi,

I have been on strong pain killer since 2005. Naturally your body gets used to and most alarmingly demands them which means that their effectiveness drops overtime. What works for me is to not take them as a routine but on the better days stretch out the duration between tablets.

I tried Amitriptyline/ Gabapentin taken with the pain medication. I didn't work for me but then everyone is different.

However, much like you partner I picked up leg injury in 2019 that required surgery. After a year, I was still struggling to walk and was contemplating getting a mobility scooter. My GP in a last attempt prescribed some Lidocaine patches. I had always been sceptical about the patches but after a week I could feel the results and was soon walking. Yesterday, I was actually digging in the garden !

The Lidocaine patches contain the anaesthetic that is used to put intravenous drips in. The patches are about the size of a postcard and can be cut to fit where you need them so they work directly where the pain is. The other benefit is unlike other painkiller, there are very few interactions and the main constraint is 12 hours on, 12 hours off.

Apparently they are quite expensive for the NHS but after a while the amount you use drops. Whilst this is for shingles it is quite a good article netdoctor.co.uk/medicines/s...

[Pairofboots]

Hi, the first thing to find out is the route of the pain. Obviously currently broken ankle complicates the picture.

There are many causes of pain, migraine, cluster headache etc, and paradoxically painkiller headache, where the pain meds actually cause pain.

Only yesterday there was something I watched re pain management. Sounds simple. It was reading out load, apparently the act of reading aloud, blocks the brain from receiving the pain messages. The brain isn't good at multitasking.

But the first step is to investigate what is causing the pain.

I hope this give something to think about and look into.