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Abstract
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OBJECTIVE: To characterize the association between traumatic brain injury (TBI) and chronic pain and pain disability in the context of comorbid conditions, posttraumatic stress disorder (PTSD) and depression to better inform care of combat veterans.
DESIGN: Retrospective cohort study using national VA clinical data. SETTING: Veterans Health Administration (VHA) medical centers and community clinics nationwide. PARTICIPANTS: 116,913 Iraq and Afghanistan veterans who received VA care between October 2007 and March 2015, completed a Comprehensive TBI Evaluation (CTBIE), and received a gold standard diagnosis of TBI (none, mild or moderate to severe). INTERVENTION: Not applicable MAIN OUTCOME MEASURE: Chronic pain defined as at least two of the same pain diagnoses ≥ 90 days apart and pain disability defined as self-reported pain causing moderate to very severe interference with daily functioning RESULTS: 57% received ≥ 1 chronic pain diagnoses. Compared to those with no TBI, PTSD or depression, there was an independent risk for chronic pain in veterans with mild TBI, which was higher in veterans with moderate to severe TBI. The risk for chronic pain was additive and highest when all three conditions-TBI, depression and PTSD were co-present [Adjusted Relative Risk, (ARR) =1.53-1.62 (1.50-1.66) for mild and moderate/severe TBI respectively plus other diagnoses]. The relationship of pain disability to TBI, PTSD and depression followed a similar additive pattern.
CONCLUSION: In combat veterans, chronic pain and pain disability are most commonly associated with TBI in conjunction with PTSD, depression or both. Integrated models of care that simultaneously address pain in conjunction with TBI, PTSD and depression will likely be the most clinically effective.
Copyright © 2017. Published by Elsevier Inc.
Language: en |