Citation

Brown-Taylor L, Jaramillo C, Eapen BC, Kretzmer T, Gavin LP, Cooper T, Pugh MJ. PM R 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, American Academy of Physical Medicine and Rehabilitation, Publisher Elsevier Publishing)

DOI

10.1002/pmrj.12526

PMID

33247558

Abstract

Polytrauma clinical triad (PCT) is the comorbid occurrence of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain after trauma. No clinical practice guideline for post-acute care of patients with PCT currently exist; instead, clinical practice guidelines have been published for the three conditions (TBI, PTSD, and pain) as distinct clinical entities. Using multiple, individual practice guidelines for a patient with PCT may lead to unintended prescription of multiple, and potentially adversely interacting medications (i.e. polypharmacy). Polypharmacy, especially that which includes central nervous system-acting medications, may lead to overdose, suicidality, and chronic symptomatology. Current individual guidelines for each condition of PCT do not address how to coordinate care for the polytraumatic diagnosis. The purpose of this Practice Management piece was to describe the unintended consequences of polypharmacy in patients with PCT and to discuss mitigation approaches including rational prescribing, nonpharmacologic alternatives, and interdisciplinary coordination. This article is protected by copyright. All rights reserved.

Language: en

Keywords

pain; polypharmacy; Traumatic brain injury; post-traumatic stress disorder; veteran