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Medicine (Baltimore). 2017 Feb;96(7):e5917. doi: 10.1097/MD.0000000000005917.

Concussion/mild traumatic brain injury-related chronic pain in males and females: A diagnostic modelling study.

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aRehabilitation Sciences Institute, Faculty of Medicine bDepartment of Occupational Science and Occupational Therapy, University of Toronto cToronto Rehabilitation Institute dDivision of Health Care and Outcomes Research, University Health Network eDivision of Epidemiology, Dalla Lana School of Public Health, University of Toronto fToronto Western Hospital, University Health Network gYouthdale Child & Adolescent Sleep Clinic hDepartment of Biology, University of Toronto, Mississauga, Ontario, Canada.


Pain is an unpleasant, complex, and perceived experience that places a significant burden on patients and clinicians. Its severity may be mediated by emotion, attitude, and environmental influences, and pain may be expressed differently in males and females. Traumatic brain injury (TBI) is frequently associated with chronic pain. This diagnostic modeling study examined sex differences in the construct of chronic pain in patients with delayed recovery from concussion/mild traumatic brain injury (mTBI).Data were collected from standardized questionnaires, neuroimaging records, and comprehensive clinical assessments. Bivariate associations were calculated using the Spearman correlation coefficient or analysis of variance. We established sex-specific stepwise multivariate linear regression models of factors associated with pain.Of the 94 participants diagnosed with mTBI (the mean age was 45.20 ± 9.94 years; 61.2% were males; the median time since injury was 197 days [interquartile range 139-416]), head/neck, and bodily pain were reported by 93% and 64%, respectively. No sex differences were identified in pain frequencies or severity. Pain was significantly associated with certain socio-demographic, injury-related, behavioral, and clinical variables. In the multivariable regression analysis, several determinants explained 60% of the pain variance in males and 46% in females.Pain is common in patients with delayed recovery from mTBI and is significantly associated with potentially modifiable clinical and nonclinical variables. Examining the multidimensional construct of pain in concussion/mTBI through a sex lens garners new directions for future longitudinal research on the pain mechanisms involved in postconcussion syndrome.

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