Pain, Depression, and Posttraumatic Stress Disorder Following Major Extremity Trauma Among United States Military Serving in Iraq and Afghanistan: Results From the Military Extremity Trauma and Amputation/Limb Salvage Study

Abstract

Objectives: Assess the burden and co-occurrence of pain, depression, and posttraumatic stress disorder (PTSD) among service members who sustained a major limb injury, and examine whether these conditions are associated with functional outcomes. Design: A retrospective cohort study. Setting: Four U.S. military treatment facilities: Walter Reed Army Medical Center, National Naval Medical Center, Brooke Army Medical Center, and Naval Medical Center San Diego. Patients/Participants: Four hundred twenty-nine United States service members who sustained a major limb injury while serving in Afghanistan or Iraq met eligibility criteria upon review of their medical records. Intervention: Not applicable. Main Outcome Measurements: Outcomes assessed were: function using the short musculoskeletal functional assessment; PTSD using the PTSD Checklist and diagnostic and statistical manual criteria; pain using the chronic pain grade scale. Results: Military extremity trauma and amputation/limb salvage patients without pain, depression, or PTSD, were, on average, about one minimally clinically important difference (MCID) from age- and gender-adjusted population norms. In contrast, patients with low levels of pain and no depression or PTSD were, on average, one to 2 MCIDs from population norms. Military extremity trauma and amputation/limb salvage patients with either greater levels of pain, and who experience PTSD, depression, or both, were 4 to 6 MCIDs from population norms. Regression analyses adjusting for injury type (upper or lower limb, salvage or amputation, and unilateral or bilateral), age, time to interview, military rank, presence of a major upper limb injury, social support, presence of mild traumatic brain injury/concussion, and combat experiences showed that higher levels of pain, depression, and PTSD were associated with lower one-year functional outcomes. Conclusions: Major limb trauma sustained in the military results in significant long-term pain and PTSD. Overall, the results are consistent with the hypothesis that pain, depression, and PTSD are associated with disability in this population. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Video Messaging to Increase Vascularized Composite Allograft Donation Willingness in United States Military Veterans

“…During the Global War on Terror, thousands of military personnel have lost limbs and suffered severe facial injuries, all with associated physical and psychological burden. 19,[27][28][29][30] Consequently, veterans and the DoD are key stakeholders in the advancement of VCA transplantation. 19 Current study findings show that veterans are sympathetic to VCA transplantation, want to learn more about it, and are willing to be a VCA donor once exposed to its benefits for injured veterans and others.…”

Level of perceived social support, and associated factors, in combat-exposed (ex-)military personnel: a systematic review and meta-analysis

“…Most samples were predominantly male (31 studies). Studies were made up of non-clinical samples (n = 12) [34-37, 39-47], probable PTSD (n = 8) [29,32,[48][49][50][51][52][53], mild TBI (n = 1) [54], physical/amputation injury (n = 3) [17,38,55] and all other treatment-seeking samples where health condition is not specified (n = 12) [24,30,31,[51][52][53][56][57][58][59][60][61]. One study investigated specific domains of social support (structural, functional), whilst three investigated type of social support (emotional, tangible).…”

“…Military samples may have unique experiences of PSS compared to the general population as comradeship and collectivism are central to military culture and essential for operational success [16]. In a sample of United States (US) (ex-)military personnel who experienced major limb trauma during Iraq/Afghanistan deployment, almost one third (27%) reported low levels of PSS [17].…”

Schmerz und Depression

“…Eine weitere Entität ist die große Gruppe traumatisierter Patienten. Auch diese sind sehr häufig depressiv und berichten über verschiedenste Schmerzen [22]. In Anbetracht der zentralen Rolle des limbischen Systems bei der Verarbeitung von Affekten im Mandelkern (Amygdala), deren Speicherung im Hippocampus im Kontext von sensorischen Eindrücken (Gerüche) und dem Verlust der klaren zeitlichen Zuordnung, ist es neurobiologisch gut nachzuvollziehen, dass depressive Affekte und Schmerzen häufige Symptome sind.…”