Association of Traumatic Brain Injury with Chronic Pain in Iraq and Afghanistan Veterans: Impact of Comorbid Mental Health Conditions

Publication date: Available online 25 April 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Karen H. Seal, Daniel Bertenthal, Deborah E. Barnes, Amy L. Byers, Irina Strigo, Kristine Yaffe
ObjectiveTo 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.DesignRetrospective cohort study using national VA clinical data.SettingVeterans Health Administration (VHA) medical centers and community clinics nationwide.Participants116,913 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).InterventionNot applicableMain Outcome MeasureChronic 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 functioningResults57% 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.ConclusionIn 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.



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