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Concussion, Chronic Pain & Diagnosis

Given MACRA and outcome assessment based compensation it is important for doctors to understand reasons for delayed recovery and justify treatment outcomes. Studies show that more than 50 percent of people suffer from chronic pain disorders in the years following a brain injury. Headaches and neuropathic (nerve-related) pain is most commonly from injury to the head and neck.


According to the ICD10 criteria, at least three symptoms, which may include headache, dizziness, fatigue, depression, irritability, difficulty in concentration, and memory problems, are required for a diagnosis of postconcussion syndrome [7].  

The study shows that patients with injury-related pain often reported post concussion symptoms several years after injury. Although more women than men participated in the study, few differences between genders were found. A significant relationship was found between postconcussion symptoms and posttraumatic stress and between postconcussion symptoms and depression and anxiety. As whiplash is reported as the most common traffic injury, it was not surprising that most patients related their chronic pain condition to a previous whiplash trauma.

Although patients reported high frequencies of symptoms, these are seldom assessed in patients with chronic injury-related pain. The results in the present study agree with Smith-Seemiller et al.; they demonstrated that post-concussion symptoms were common in patients with chronic pain [19]. Since several studies have shown a lack of specificity of PCS [15, 28], the challenge is to establish a causal link between MTBI and PCS and to the diagnosis post-concussion disorder. According to our findings, the optimization of treatment for PCS requires clinicians to assess postconcussion symptoms, to investigate causes for each patient, and to account for factors such as posttraumatic stress and depression.


*See Post Concussion Chronic Pain below.

Concussion Diagnosis

The final decision on diagnosis and coding is up to the doctor. Chiropractors should check with their state licensing board regarding making these types of diagnosis.

TBI Diagnosis

Veterans Administration TBI Coding Guidance

Differential Diagnosis

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