Citation

Blakey SM, Wagner HR, Naylor J, Brancu M, Lane I, Sallee M, Kimbrel NA, Elbogen EB. J. Pain 2018; 19(7): 797-806.

Affiliation

Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705 USA; Durham VA Medical Center, Durham, NC 27705 USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705 USA.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.jpain.2018.02.012

PMID

29526669

Abstract

The polytrauma clinical triad refers to the co-occurrence of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Despite research implicating dyadic relationships between these conditions and adverse outcomes, scant research has examined the polytrauma clinical triad's relation to suicide or violence. The present cross-sectional study was designed to examine whether this complex clinical presentation increases risk of suicidal ideation and violent impulses after accounting for other established risk factors. Veterans who served in the military since 9/11/01 (N = 667) who reported chronic pain completed an interview and self-report battery. Bivariate analyses showed that suicidal ideation and violent impulses both correlated with PTSD, TBI+PTSD, pain intensity and interference, drug abuse, and major depressive disorder (MDD). Multiple regression analyses showed that (a) race, chronic pain with PTSD, alcohol abuse, and MDD significantly predicted suicidal ideation, (b) pain interference, chronic pain with TBI, chronic pain with PTSD, chronic pain with TBI+PTSD, drug abuse, and MDD significantly predicted violent impulses, and (c) pain interference was a more critical predictor of suicidal and violent ideation than pain intensity. Implications for risk assessment and treatment are discussed. PERSPECTIVE: This article presents results from a study examining predictors of suicide and violence risk among a sample of post-9/11 United States Veterans with chronic pain. Healthcare professionals should assess for pain interference, TBI, posttraumatic stress disorder, depression, and alcohol/drug abuse when conducting risk assessments with this population.

Copyright © 2018. Published by Elsevier Inc.

Language: en

Keywords

chronic pain; posttraumatic stress disorder; suicide; traumatic brain injury; violence