Dr. Boodin on Pain Management and Concussion Recovery

Question:

With your background in pain management, what are some of the challenges you commonly encounter when treating injured workers with persistent pain? Are there particular factors that can influence a worker’s recovery?

Answer:

Common challenges treating workers with persistent pain include finding the right modalities to help (physical therapy, chiropractic care, massage, acupuncture, etc.), the appropriate medications to treat with minimal side effects, getting the worker to appropriate specialists in a timely fashion if needed, and the worker staying consistent with their treatment plan.

When a worker has consistent treatments with appropriate modalities, they typically have an easier recovery. When they have a history of chronic pain, extensive medical problems, comorbid physical/mental health conditions, or multiple injuries in the past, this can be a challenge in their recovery. Workers who have sensitivities to medications and/or experience side effects can be particularly challenging to treat as well.

Ideally, a worker gets consistent treatment with modalities/medications that may aid in their recovery. I have also found modalities such as meditation, breathing techniques, and mental health care can aid in the recovery of an injured worker.

Question:

How do concussions and other traumatic brain injuries differ, and how can those differences affect treatment and expected recovery?

Answer:

A concussion is a traumatic brain injury. A traumatic brain injury can be mild, moderate, or severe, and there are specific criteria to diagnose the level of traumatic brain injury.

The treatment of the brain injury depends on the severity of the brain injury and the symptoms the patient is experiencing. The diagnosis and treatment can be very difficult, as it can be quite subjective from the patient’s point of view.

Although there may be objective findings such as changes on imaging (skull fractures, intracranial bleeds, contusions, etc.), neurologic findings on examination, and changes on neuropsychological testing, many times the diagnosis and treatment of concussion is dependent on reported symptoms from the patient.

The more severe the traumatic brain injury, the more difficult and longer the recovery typically takes. If the patient has had previous concussions, this can also affect and/or prolong their recovery from subsequent concussions or traumatic brain injuries. A previous concussion/traumatic brain injury can cause more severe subsequent concussions/traumatic brain injuries or prolong the recovery timeline for subsequent concussion/traumatic brain injuries.

Question:

When symptoms such as headaches, dizziness, memory difficulties, or problems with concentration persist following a concussion, how do you approach the evaluation and treatment of those ongoing symptoms?

Answer:

Symptoms such as headaches, dizziness, memory difficulties, or problems with concentration are difficult to assess, as these are subjective symptoms. The patient may or may not have changes on their neurological exam to coincide with these reported symptoms.

I rely on therapy notes (physical therapy, occupational therapy, speech therapy) to help me see exactly where patients are experiencing difficulties. Ideally, a patient will be able to have neuropsychological testing, but this is extremely difficult to obtain, especially in a timely fashion.

Neuropsychological testing is extremely helpful in delineating cognitive difficulties attributed to a concussion versus other causes. I will also look at the trajectory of recovery, especially with therapy notes. This can help me determine if they are on a recovery course consistent with concussion or if symptoms are persisting despite treatment.

Natalie Boodin, M.D., is a board-certified physical medicine and rehabilitation physician with extensive experience in workers’ compensation, pain management, traumatic brain injuries, and concussion. She earned her medical degree from Ohio State University and completed her residency in physical medicine and rehabilitation at Schwab Rehabilitation Hospital, University of Chicago.

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