Citation

Seal KH, Bertenthal D, Barnes DE, Byers AL, Gibson CJ, Yaffe K. J. Pain 2018; 19(8): 931-941.

Affiliation

San Francisco Veterans Affairs Health Care System; University of California, San Francisco, San Francisco, CA.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.jpain.2018.03.005

PMID

29597083

Abstract

Clinical practice guidelines admonish against prescribing opioids for individuals with chronic pain and traumatic brain injury (TBI) given increased risk for adverse outcomes, yet no studies have described opioid prescribing patterns in these higher risk patients. Between October 2007 and March 2015, 53,124 Iraq and Afghanistan veterans with chronic pain not prescribed opioids in the previous year were followed for one year after completing a Comprehensive TBI Evaluation (CTBIE) within Department of Veterans Affairs health care facilities. Veterans reporting the most severe TBI sequelae (e.g., loss of consciousness > 30 minutes) were significantly more likely to receive short-term and long-term opioid therapy than those with less severe or no TBI sequelae (p-values < 0.001). In analyses adjusted for sociodemographics, military service, pain disability, and prior non-opioid treatment modalities, veterans with moderate to severe TBI had a significantly increased risk of receiving opioid therapy. Veterans with moderate to severe TBI plus comorbid PTSD and depression had an even greater risk of initiating long-term opioid therapy in the year following CTBIE [Adjusted Relative Risk=3.57 (95% Confidence Interval=2.85,4.47)]. Higher-risk patients with chronic pain and TBI with mental health comorbidities may benefit from improved access to behavioral health and non-pharmacological therapies for chronic pain. PERSPECTIVE: Paradoxically, veterans with greater traumatic brain injury (TBI) severity and comorbid mental health burden are more likely to be prescribed opioids for chronic pain. More vulnerable veterans may benefit from improved access to behavioral health and non-pharmacological modalities for chronic pain, given the health and safety risks of opioids.

Copyright © 2018. Published by Elsevier Inc.

Language: en

Keywords

Chronic Pain; Opioids; Posttraumatic Stress Disorder; Traumatic Brain Injury; Veterans