Disparities in Chronic Pain Experience and Treatment History Among Persons With Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study.

OBJECTIVE: To determine disparities in pain severity, pain interference, and history of pain treatment for non-Hispanic Whites, non-Hispanic Blacks, and Hispanics with traumatic brain injury (TBI) and chronic pain. SETTING: Community following discharge from inpatient rehabilitation. PARTICIPANTS: A total of 621 individuals with medically documented moderate to severe TBI who had received acute trauma care and inpatient rehabilitation (440 non-Hispanic Whites, 111 non-Hispanic Blacks, and 70 Hispanics). DESIGN: A multicenter, cross-sectional, survey study. MAIN MEASURES: Brief Pain Inventory; receipt of opioid prescription; receipt of nonpharmacologic pain treatments; and receipt of comprehensive interdisciplinary pain rehabilitation. RESULTS: After controlling for relevant sociodemographic variables, non-Hispanic Blacks reported greater pain severity and greater pain interference relative to non-Hispanic Whites. Race/ethnicity interacted with age, such that the differences between Whites and Blacks were greater for older participants (for severity and interference) and for those with less than a high school education (for interference). There were no differences found between the racial/ethnic groups in the odds of having ever received pain treatment. CONCLUSIONS: Among individuals with TBI who report chronic pain, non-Hispanic Blacks may be more vulnerable to difficulties managing pain severity and to interference of pain in activities and mood. Systemic biases experienced by many Black individuals with regard to social determinants of health must be considered in a holistic approach to assessing and treating chronic pain in individuals with TBI.

Affect recognition in traumatic brain injury: responses to unimodal and multimodal media.

OBJECTIVES: To compare affect recognition by people with and without traumatic brain injury (TBI) for (1) unimodal and context-enriched multimodal media; (2) positive (happy) and negative emotions; and (3) neutral multimodal stimuli. PARTICIPANTS: A total of 60 people with moderate to severe TBI and 60 matched controls. MEASURES: (1) facial affect, (2) vocal affect, and (3) multimodal affect. RESULTS: Compared with controls, people with TBI scored significantly lower on both unimodal measures but not on the multimodal measure. Within- group comparisons for people with TBI revealed that they were better at recognizing affect from multimodal than unimodal stimuli. As a group, participants with TBI who were categorized as having impaired facial/vocal affect recognition were less accurate at recognizing all emotions, including happy, than unimpaired participants. Neutral stimuli were more poorly identified by participants with TBI than by those with controls. CONCLUSION: Context-enriched multimodal stimuli may enhance affect recognition for people with TBI. People with TBI who have impaired affect recognition may have problems identifying both positive (happy) and negative expressions. Furthermore, people with TBI may perceive affect when there is none.

Using startle to objectively measure anger and other emotional responses after traumatic brain injury: a pilot study.

OBJECTIVE: To determine the effectiveness of a modulated acoustic startle reflex paradigm with emotional imagery in studying physiological changes associated with emotional responses in persons with traumatic brain injury (TBI). SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Six individuals with moderate to severe TBI. Mean age was 32 years and mean years postinjury were 9.9. METHOD: The modulated acoustic startle reflex procedure involved imagery of emotional scripts (joy, anger, fear, and neutral) followed by a startle noise, versus startle noise alone (no script). MEASURES: Eyeblink and skin conductance response, subjective arousal and valence ratings of the scripts, and general anger questionnaire. RESULTS: Startle blink responses following anger imagery were significantly smaller than those following fear (P = .006) and neutral (P = .023) imagery. Skin conductance response did not change significantly based on the content of the scripts (P = .070). CONCLUSIONS: Large startle blink responses indicate avoidance of a stimulus. Our findings suggest that participants with TBI did not have an avoidant reaction to anger-inducing stimuli. Skin conductance response findings may imply arousal impairments. The modulated acoustic startle reflex was effective in measuring emotional responses; however, larger studies comparing persons with TBI with control groups are needed to further explore these findings.