Correlates of Pain Symptoms among Iraq and Afghanistan Military Personnel Following Combat-Related Blast Exposure

By Stratton, Kelcey J.; Hawn, Sage E. et al. | Journal of Rehabilitation Research & Development, August 2014 | Go to article overview

Correlates of Pain Symptoms among Iraq and Afghanistan Military Personnel Following Combat-Related Blast Exposure


Stratton, Kelcey J., Hawn, Sage E., Amstadter, Ananda B., Cifu, David X., Walker, William C., Journal of Rehabilitation Research & Development


INTRODUCTION

A growing literature supports a relationship between pain conditions and psychiatric disorders such as depression and posttraumatic stress disorder (PTSD). Pain and PTSD are particularly significant problems for military Veterans; up to 20 percent of returning Veterans meet criteria for PTSD [1-2], and moreover, data from a range of deployment eras suggest that up to 80 percent of Veterans seeking treatment for PTSD also experience pain [3-8]. Despite some differences in injury characteristics and pain locations that vary by deployment era, the results of previous work support a relationship between the presence and severity of PTSD symptoms and increased pain level and pain disability and poorer health outcomes among Veterans [3-4]. However, among the Active Duty servicemembers (SMs) and Veterans of Operation Iraqi Freedom/ Operation Enduring Freedom/Operation New Dawn (OIF/ OEF/OND), the association between pain and PTSD is further complicated by the sequelae of exposure to blasts, such as those caused by improvised explosive devices (IEDs), rocket-propelled grenades, and other explosive munitions [9]. Blast-related injuries have emerged as one of the chief concerns for returning military personnel, resulting in a devastating, complex array of outcomes that includes neurocognitive difficulties associated with traumatic brain injury (TBI), psychiatric disorders, and pain syndromes (e.g., Lew et al. [6] and Cifu et al. [10]). Indeed, the complexity of these combat-related injuries has led some researchers to suggest that a polytraumatic injury profile (i.e., the presence of multiple injuries) may best describe the negative health consequences associated with recent combat operations because returning SMs and Veterans tend to experience multiple medical problems [10]. Therefore, more study is needed to understand the unique risk factors and symptom comorbidity patterns in the context of polytraumatic injuries among OIF/OEF/ OND military personnel in order to best inform prevention and secondary intervention efforts, particularly as these individuals increasingly begin to transition from Active Duty military service and seek ongoing healthcare.

Recent studies of pain, PTSD, and blast-related neurocognitive difficulties, including TBI and persistent post-concussive syndrome (PPCS), have found high cooccurrence of these conditions among OIF/OEF/OND Veterans. Results from two studies of nationally representative samples of OIF/OEF/OND Veterans enrolled in Department of Veterans Affairs (VA) healthcare reveal high prevalence rates of psychiatric disorders (9.5%42.0%) and pain complaints (20%-33%), with the prevalence of co-occurring PTSD and/or pain increasing significantly among Veterans with diagnosed TBI (54%-73%) [10-11]. Regarding specific polytrauma clinical samples, Lew et al. determined that the coprevalence rate of chronic pain, PTSD, and PPCS among OIF/OEF/OND Veterans was roughly 42 percent, indicating a high degree of comorbidity for these three conditions [6]. In fact, the results suggested a higher likelihood of having concurrent diagnoses for two or all of the disorders than of receiving a diagnosis for any individual condition alone. Additional research conducted in other Veteran and civilian samples likewise suggests that pain and PTSD [12] and pain and depression [13] are more likely to manifest as comorbidities rather than as individual conditions.

Etiologic models of pain and comorbid disorders purport a complex interaction of biological and psychosocial factors, and considering the heterogeneity of polytrauma injuries, findings regarding symptom development and comorbidity models are mixed. Moreover, a variety of psychosocial factors have been linked to pain and related conditions. Prevalence of pain symptoms and/or pain-related disability increases with age [14] and may also vary among other demographic characteristics such as education [8,15], socioeconomic status [16], and sex [8,17]. …

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