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Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans.
Pain Med. 2016 11; 17(11):2017-2025.PM

Abstract

OBJECTIVE

Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are common among US veterans of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). We postulated that these injuries may modulate pain processing in these individuals and affect their subjective pain levels.

DESIGN

Cross-sectional.

SUBJECTS

310 deployed service members of OEF/OIF/OND without a lifetime history of moderate or severe TBI were included in this study.

METHODS

All participants completed a comprehensive evaluation for Blast Exposure, mTBI, PTSD, and Pain Levels. The Boston Assessment of TBI-Lifetime Version (BAT-L) was used to assess blast exposure and potential brain injury during military service. The Clinician-Administered PTSD Scale (CAPS) characterized presence and severity of PTSD. The Visual Analog Scale (VAS) was used to assess pain intensity over the previous month before the interview, with higher scores indicative of worse pain. Statistical analysis was performed by ANOVA and results were adjusted for co-morbidities, clinical characteristics and demographic data.

RESULTS

In comparison to control participants (veterans without mTBI or current PTSD), veterans with both current PTSD and mTBI reported the highest pain intensity levels, followed by veterans with PTSD only (P < 0.0001 and P = 0.0005, respectively). Pain levels in veterans with mTBI only were comparable to control participants.

CONCLUSIONS

Comorbid PTSD and mTBI is associated with increased self-reported pain intensity. mTBI alone was not associated with increased pain.

Authors+Show Affiliations

*Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts mpstojanovic@gmail.com.Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts. Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.*Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts. Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts. Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA.Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

27040665

Citation

Stojanovic, Milan P., et al. "Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) On Pain Intensity Levels in OEF/OIF/OND Veterans." Pain Medicine (Malden, Mass.), vol. 17, no. 11, 2016, pp. 2017-2025.
Stojanovic MP, Fonda J, Fortier CB, et al. Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans. Pain Med. 2016;17(11):2017-2025.
Stojanovic, M. P., Fonda, J., Fortier, C. B., Higgins, D. M., Rudolph, J. L., Milberg, W. P., & McGlinchey, R. E. (2016). Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans. Pain Medicine (Malden, Mass.), 17(11), 2017-2025.
Stojanovic MP, et al. Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) On Pain Intensity Levels in OEF/OIF/OND Veterans. Pain Med. 2016;17(11):2017-2025. PubMed PMID: 27040665.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans. AU - Stojanovic,Milan P, AU - Fonda,Jennifer, AU - Fortier,Catherine Brawn, AU - Higgins,Diana M, AU - Rudolph,James L, AU - Milberg,William P, AU - McGlinchey,Regina E, Y1 - 2016/04/03/ PY - 2016/4/5/pubmed PY - 2017/9/22/medline PY - 2016/4/5/entrez KW - Chronic Pain KW - Post-Traumatic Stress Disorder KW - Traumatic Brain Injury SP - 2017 EP - 2025 JF - Pain medicine (Malden, Mass.) JO - Pain Med VL - 17 IS - 11 N2 - OBJECTIVE: Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are common among US veterans of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). We postulated that these injuries may modulate pain processing in these individuals and affect their subjective pain levels. DESIGN: Cross-sectional. SUBJECTS: 310 deployed service members of OEF/OIF/OND without a lifetime history of moderate or severe TBI were included in this study. METHODS: All participants completed a comprehensive evaluation for Blast Exposure, mTBI, PTSD, and Pain Levels. The Boston Assessment of TBI-Lifetime Version (BAT-L) was used to assess blast exposure and potential brain injury during military service. The Clinician-Administered PTSD Scale (CAPS) characterized presence and severity of PTSD. The Visual Analog Scale (VAS) was used to assess pain intensity over the previous month before the interview, with higher scores indicative of worse pain. Statistical analysis was performed by ANOVA and results were adjusted for co-morbidities, clinical characteristics and demographic data. RESULTS: In comparison to control participants (veterans without mTBI or current PTSD), veterans with both current PTSD and mTBI reported the highest pain intensity levels, followed by veterans with PTSD only (P < 0.0001 and P = 0.0005, respectively). Pain levels in veterans with mTBI only were comparable to control participants. CONCLUSIONS: Comorbid PTSD and mTBI is associated with increased self-reported pain intensity. mTBI alone was not associated with increased pain. SN - 1526-4637 UR - https://www.unboundmedicine.com/medline/citation/27040665/Influence_of_Mild_Traumatic_Brain_Injury__TBI__and_Posttraumatic_Stress_Disorder__PTSD__on_Pain_Intensity_Levels_in_OEF/OIF/OND_Veterans_ L2 - https://academic.oup.com/painmedicine/article-lookup/doi/10.1093/pm/pnw042 DB - PRIME DP - Unbound Medicine ER -