The Impact of Pain and Analgesic Medication Following Acquired Brain Injury

Direct Consequences of Pain include the following:

• Forced immobility or loss of function, which may limit physical recovery.
• Aggravation of spasticity, which may limit physical recovery.
• Emotional and behavioural consequences e.g. frustration, low mood increased irritability & confusion.
• Fatigue.
• Distraction, which may exacerbate cognitive and behavioural difficulties.
• Reduced engagement in rehabilitation due to distraction, fatigue and emotional impact.
• Exacerbation of incontinence issues due to fatigue, distraction and immobility.
• Loss of appetite.
• Adverse effect on wound care. The skin is more vulnerable as a result of:
  • Pressure effects arising from immobility.
  • The impact of spasticity, resulting in shearing forces at wound site.
  • Increased potential for incontinence.
  • Nutritional deficiencies as a result of reduced appetite.
• Social isolation.

 

Common Consequences of Analgesic Medication include the following:

1. Opioids:
   • Sedation resulting in exacerbation of cognitive difficulties.
   • Increased problems with constipation. It has a direct impact on bowel mobility.
   • Reduced appetite due to sedative side effects and nausea.
   • Interaction with other sedative medications (e.g. neuropathic agents; anti-spasticity medications; medications for agitation).
   • May aggravate problems with sodium balance/SIADH.
   • Potential for withdrawal syndromes including opiate related headache.

2. Neuropathic Agents:
   • Sedation resulting in exacerbation of cognitive difficulties.
   • Reduced appetite related to sedative effect, nausea and altered liver function.
   • Interaction with other sedative medications (other neuropathic agents; opioids, anti-spasticity medications; medications for agitation).
   • May aggravate problems with sodium balance/SIADH.
   • Antidepressant medication may lower seizure threshold.
   • Antidepressant medication may have autonomic effects which adversely affect bladder emptying and bowel motility.

3. NSAIDs:
   • Peptic ulceration risk, particularly in patients who may not be able to describe relevant symptoms.
   • Adverse impacts on blood pressure control and renal function.

4. Paracetamol:
   • Potential adverse impact on renal and liver function.