Journal of Rehabilitation Research & Development (JRRD)

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Volume 51 Number 4, 2014
   Pages 559 — 570

Abstract — Pain experience of Iraq and Afghanistan Veterans with comorbid chronic pain and posttraumatic stress

Samantha D. Outcalt, PhD;1–2* Dennis C. Ang, MD;3 Jingwei Wu, MS;4 Christy Sargent, BA;1 Zhangsheng Yu, PhD;4 Matthew J. Bair, MD, MS1,5

1Department of Veterans Affairs (VA) Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, IN; 2Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN; 3Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC; 4Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN; 5Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; and Regenstrief Institute, Inc, Indianapolis, IN

Abstract — Chronic pain and posttraumatic stress disorder (PTSD) co-occur at high rates, and Veterans from recent wars in Iraq and Afghanistan may be particularly vulnerable to both conditions. The objective of this study was to identify key aspects of chronic pain, cognitions, and psychological distress associated with comorbid PTSD among this sample of Veterans. Baseline data were analyzed from a randomized controlled trial testing a stepped-care intervention for chronic musculoskeletal pain. Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans with chronic pain only (n = 173) were compared with those with chronic pain and clinically significant posttraumatic stress symptoms (n = 68). Group differences on pain characteristics, pain cognitions, and psychological distress were evaluated. Results demonstrated that OIF/OEF Veterans with comorbid chronic musculoskeletal pain and PTSD experienced higher pain severity, greater pain-related disability and increased pain interference, more maladaptive pain cognitions (e.g., catastrophizing, self-efficacy, pain centrality), and higher affective distress than those with chronic pain alone. Veterans of recent military conflicts in Iraq and Afghanistan may be particularly vulnerable to the compounded adverse effects of chronic pain and PTSD. These results highlight a more intense and disabling pain and psychological experience for those with chronic pain and PTSD than for those without PTSD.

Clinical Trial Registration: ClinicalTrials.gov; NCT00386243. “Evaluation of Stepped Care for Chronic Pain in Iraq/Afghanistan Veterans (ESCAPE)”; http://www.clinicaltrails.gov/ct2/show/ NCT00386243.

Key words: chronic pain, cognitions, comorbidity, mental health, musculoskeletal pain, pain severity, posttraumatic stress, trauma, Veterans, Veteran health.


View HTML ¦ View PDF ¦ Contents Vol. 51, No.4

This article and any supplemental material should be cited as follows:
Outcalt SD, Ang DC, Wu J, Sargent C, Yu Z, Bair MJ. Pain experience of Iraq and Afghanistan Veterans with comorbid chronic pain and posttraumatic stress. J Rehabil Res Dev. 2014;51(4):559–70.
http://dx.doi.org/10.1682/JRRD.2013.06.0134
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