Increased sensitivity to touch, temperature and even movement/vibration may occur following brain injury. In some cases even relatively light touch can cause discomfort and pain. This can make it difficult for the person to tolerate everyday activities such as bathing, dressing, hair brushing etc.
It is important to try and identify other possible causes of sensitivity to touch and movement:
- Conditions causing chronic pain e.g. persistent headaches, arthritis etc.
- Pain arising from spasticity.
- Neuropathic pain.
- Psychological and psychiatric difficulties e.g. high levels of anxiety.
- Behaviour which reinforces the problem e.g. avoiding bathing because of sensitivity to temperature may further increase and compound the problem.
- Some skin conditions.
- Consider other potentially important causative medical conditions and contributory factors.
Following a significant brain injury some people may occasionally (as may occur following a stroke) develop central pain, also known as neuropathic pain. This has most commonly been reported in association with damage to the thalamus, brainstem, subcortical white matter and cerebral cortex. Neuropathic pain means that abnormal sensations (dysaesthesia) are experienced by the person. They experience pain/discomfort in association with:
- Stimuli which do not normally cause pain e.g. light touch, sensations of hot/cold.
- Increased sensitivity to painful stimuli (hyperalgesia).
- Abnormal sensations (dysaesthesia).
How to Help:
- A clear management plan is required. This is best
supported by professionals with relevant experience e.g. brain injury specialist, pain management specialist, Clinical Psychologist. - Provide reassurance and explanation.
- It can be helpful to remove obvious irritants such as clothing labels.
- Encouraging the person to be as independent as possible during care procedures may be helpful in symptom management.
- Do not startle or surprise the person by suddenly touching them, brushing their hair or commencing a personal care activity without prior warning: tell the person what you are going to do before you do it and show them the relevant items (hairbrush, flannel etc).
- Try to reduce the impact of mental health difficulties e.g. high levels of anxiety.
- A desensitisation programme of controlled and increasing exposure to the uncomfortable stimuli is likely to be the most effective treatment. However if cognitive difficulties are a significant contributory factor, then an alternative management approach may be required. Seek specialist advice e.g. from brain injury specialist, pain management specialist, Clinical Psychologist.
