The stress and frustration at not being ‘well’ – and not knowing why?

WESTBOROUGH, MA February 5, 2017 There is growing frustration in my practice about the lack of “treatment” for concussion and postconcussion syndrome or PCS.  There are many people whose lives have been changed because of one or more than one concussion occurring in close succession.  I am currently seeing a number of cases of individuals who suffer with the symptoms of PCS and are miserable. Over time they have grown hypervigilant about every sign or symptom they experience attributing them to the concussion from long ago. Long term symptoms include headaches, poor memory, low endurance, neck and body pain, tinnitis, feeling like being in a mental fog. I might add that the stress of PCS diectly contributes to changes in mood including: depression and anxiety. People with PCS are at higher risk of substance abuse while recovering.
5-15 percent of peple who sustain a concussion can expect to have symptoms that excede the normal 7-10 day window.  Those who report symptoms greater that 3-6 months are diagnosed with PCS.  I’ve been reading the blog of one PCS sufferer who is eloquent in her description of the impact of concussion on her young adult life. She shares her frustration and fear over not getting better and just as importantly no being understood.  I hear that to many times – nobody listens and nobody understands just how much they suffer. Many grow accusatory and suspicious that the primary physician is denying them the medical care or diagnostic tests they need to find answers and utlimately to recover.
Sometimes vague physical symptoms create an overwhelming emotional response that may come from lingering resentment felt when seeing doctors who seem unable to understand their needs. I always recommend that patients practice a script so that when seeing the specialist they are able to present themselves and their suffering, including all symptoms, in a cohesive understandable manner. Strangely the outward appearance of lingering concussion may appear to be solely a psychiatric condition rather than someone who is recovering from a brain injury. Some physicians unfairly believe prolonged symptoms may be linked to ongoing litigation and are magnified as a way of deriving greater compensation.
In a published blog from September 2016 I have addressed secondary trauma that may confound the recovery from brain injury when it occurs concurrently. Coincident acute stress may exacerbate the physical symptoms and duration of symptoms following concussion and make healing an arduous process.
“A history of migraine headaches may be a predictor of post concussive headaches. Other stressors like divorce, loss, financial problems, motor vehicle crash and others may change the trajectory of recovery.” Sefton, 2016
If someone you know suffers from PCS the effects to a family system can be dramatic too especially when the head of household can no longer go to work.  Whether it is a professional, elite student athlete or a salesman injured in a car crash there is an experience of stigma associated with the invisible injury of concussion. It is increasingly understood that concussion interferes with the efficiency of central nervous system functioning slowing it down.  This is why cognitive rest is recommended so automatically for those newly diagnosed. When the cognitive demand excedes the mental resources available there is a “energy mismatch” that puts a stall on the recovery.
Evidently, there’s no monolithic prescription for treating PCS, which results in much of the work, research, and accountability for getting better being placed onto the patient. It’s a process of trial and error, albeit a very long, frustrating one” according to one blogger who has had PCS for over 2 years. Hockey gal blog

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