Abstract
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.
Setting
Medical centers and community clinics.
Participants
Combat veterans (N=116,913) who received Veterans Affairs care between October 1,
2007 and March 31, 2015, completed a Comprehensive Traumatic Brain Injury Evaluation,
and received a criterion standard diagnosis of TBI (none, mild, or moderate to severe).
Interventions
Not applicable.
Main Outcome Measures
Chronic pain defined as ≥2 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
Fifty-seven percent received ≥1 chronic pain diagnosis. 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
of chronic pain was additive and highest when all 3 conditions—TBI, depression, and
PTSD—were copresent (adjusted relative risk, 1.53 and 1.62 [95% confidence interval,
1.50–1.66] for mild and moderate or severe TBI, respectively, plus other diagnoses).
The relation of pain disability to TBI, PTSD, and depression followed a similar additive
pattern.
Conclusions
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.
Keywords
List of abbreviations:
ARR (adjusted relative risk), CDW (Corporate Data Warehouse), CI (confidence interval), CTBIE (Comprehensive Traumatic Brain Injury Evaluation), GLM (generalized linear model), OEF (Operation Enduring Freedom), OIF (Operation Iraqi Freedom), OND (Operation New Dawn), PTSD (posttraumatic stress disorder), TBI (traumatic brain injury), VA (Veterans Affairs)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 25, 2017
Footnotes
Supported by the Veterans Health Administration Clinical Sciences Research and Development (grant no. I01 CX001246) and by the Department of Defense (grant no. W81XWH-13-2-0095). The funders had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Disclosures: Kristine Yaffe serves on data and safety monitoring boards for Takeda (outside the submitted work). The other authors have nothing to disclose.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
