SLEEP AND PAIN COMPLAINTS IN SYMPTOMATIC TRAUMATIC BRAIN INJURY AND NEUROLOGIC POPULATIONS

Objective: To compare the incidence of sleep and pain complaints in sy mptomatic traumatic brain injury (TBI) (mild vs moderate/severe) and n eurologic populations. Design: Case-control study. Setting: Outpatient neuropsychology service at a university-affiliated tertiary care cent er. Patients: A consecutive sample of mild (n=127) and moderate to sev ere (n=75) patients with TBI and a general neurologic (non-TBI) group (n=123) referred for neuropsychological assessment. Main Outcome Measu res: Patient report of sleep and/or pain problems. Results: TBI subjec ts had significantly more insomnia (56.4% vs 30.9%) and pain complaint s (58.9% vs 22%) than non-TBI subjects (p <.0001). For both subject gr oups, the presence of pain increased insomnia approximately twofold. P oor sleep maintainance was the most common sleep problem. In those sub jects without pain, TBI patients reported more sleep complaints that n on-TBI patients (p=.05). Mild TBI patients reported significantly (p < .0001) more pain than patients with a moderate to severe injury (70% v s 40%). In TBI subjects without pain, there were significantly more in somnia complaints in mild than in moderate to severe injuries (p <.01) . Conclusions: TBI patients with persistent cognitve complaints have m ore sleep and pain concerns than general neurologic patients. Pain is strongly associated with sleep problems. Aggressive evaluation and tre atment of pain and sleep problems in the TBI, especially mild TBI, pop ulation appears warranted and may contribute to increased disability. The etiology of greater sleep and pain problems in the mild than in th e more severe TBI patients requires further study. (C) 1996 by the Ame rican Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.