Sleep, Fear Avoidance and Coping After Concussion

Sleep quality, sleep disturbance and fatigue are presented as some of the strongest predictors of persisting symptoms in both pain and persistent post-concussion symptoms. CBT for insomnia is recommended, with stimulus control, sleep restriction and cognitive restructuring as methods. Paul then shows how pain models apply to concussion. The fear avoidance model holds in this group, and catastrophizing is linked to more symptoms and avoidance. Avoidance coping is managed with exposure-based approaches, while endurance coping and boom-bust cycles are managed with pacing or flexible persistence, where the person chooses to accept a possible flare-up in pursuit of a meaningful goal. Two studies support active approaches: moderate physical activity such as walking was linked to better pain inhibition after concussion, and a Danish group program built on pain management principles reduced symptoms more than standard care at six months. The part closes with a summary that PPCS shares many features with persistent musculoskeletal pain and benefits from a holistic plan.