Finding the person behind the pain: chronic pain management in a patient with traumatic brain injury.

Chronic pain is common after a traumatic brain injury. Cognitive impairment post injury may be a consequence of the brain injury alone, or in combination with pain, clinical depression, and psychological and emotional factors. We present a case of a severely cognitively impaired person post-traumatic brain injury, whose behavior included social withdrawal, irritability, and agitation around direct care--which was unresponsive to psychotropic intervention or care delivery strategies. The introduction of an opioid made a significant improvement in the cognition and quality of life of the individual. This case suggests that clinicians should consider a trial of opioid analgesics in individuals with brain injury who have significant cognitive impairment in association with other behaviors suggestive of depression and pain.