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

Outcalt, Samantha D.; Ang, Dennis C.; Wu, Jingwei; Sargent, Christy; Yu, Zhangsheng; Bair, Matthew J.

doi:10.1682/jrrd.2013.06.0134

Cited by 67 publications

(32 citation statements)

References 59 publications

(77 reference statements)

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“…Dopamine receptor subtypes may have synergistic actions at the amygdala, whereby the aforementioned upregulation of dopamine type 1 receptors decreases inhibition while upregulation of dopamine type 2 receptors increases responsivity (Friedman, 2015), contributing to disruptions in the endogenous opioid system (Vanderkolk, 1994). Opioid dysregulation may contribute to high rates of chronic pain among patients with PTSD (Beckham et al, 1997; Outcalt et al, 2014), prompting high levels of opioid pain medication use (Outcalt et al, 2014; Phifer et al, 2011), which puts this population at risk for the development of OUDs (Chou et al, 2009; Edlund, Steffick, Hudson, Harris, & Sullivan, 2007). …”

Section: Introductionmentioning

confidence: 99%

Trends in Opioid Use Disorder Diagnoses and Medication Treatment Among Veterans With Posttraumatic Stress Disorder

Shiner

Westgate

Bernardy

et al. 2017

Journal of Dual Diagnosis

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Objective: Despite long-standing interest in posttraumatic stress disorder (PTSD) and opioid use disorder (OUD) comorbidity, there is a paucity of data on the prevalence of OUD in patients with PTSD. Therefore, there is limited understanding of the use of medications for OUD in this population. We determined the prevalence of diagnosed OUD and use of medications for OUD in a large cohort of patients with PTSD. Methods: We obtained administrative and pharmacy data for Veterans who initiated PTSD treatment in the Department of Veterans Affairs (VA) between 2004 and 2013 (n=731,520). We identified those with a comorbid OUD diagnosis (2.7%; n=19,998) and determined whether they received a medication for OUD in the year following their initial clinical PTSD diagnosis (29.6%; n=5,913). Using logistic regression, we determined the predictors of receipt of OUD medications. Results: Comorbid OUD diagnoses increased from 2.5% in 2004 to 3.4% in 2013. Patients with comorbid OUD used more health services and had more comorbidities than other patients with PTSD. Among patients with PTSD and comorbid OUD, use of medications for OUD increased from 22.6% to 35.1% during the same time period. Growth in the use of buprenorphine (2.0% to 22.7%) was accompanied by relative decline in use of methadone (19.3% to 12.7%). Patients who received buprenorphine were younger and more likely to be rural, white, and married. Patients who received methadone were older, urban, unmarried, from racial and ethnic minorities, and were more likely to see substance abuse specialists. While use of naltrexone increased (2.8% to 8.6%), most (87%) patients who received naltrexone also had an alcohol use disorder. Controlling for patient factors, there was a substantial increase in the use of buprenorphine, a substantial decrease in the use of methadone, and no change in use of naltrexone across years. Conclusions: OUD is an uncommon but increasing comorbidity among patients with PTSD. Patients entering VA treatment for PTSD have their OUD treated with opioid agonist treatments in large and increasing numbers. There is a need for research both on the epidemiology of OUD among patients with PTSD and on screening for OUD.

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Section: Introductionmentioning

confidence: 99%

Trends in Opioid Use Disorder Diagnoses and Medication Treatment Among Veterans With Posttraumatic Stress Disorder

Shiner

Westgate

Bernardy

et al. 2017

Journal of Dual Diagnosis

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“…In addition to potential gender differences with respect to pain experiences and reporting, prior research has consistently demonstrated a positive association between pain chronicity and emotional distress, impaired function, and health care utilization [19][20][21]. Iraq/Afghanistan-era veterans reporting pain symptoms often have comorbid mental health problems, such as posttraumatic stress disorder (PTSD) [15,22], depression [15], traumatic brain injury [22][23][24], substance use disorders [25], and increased rates of suicidal ideation [26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Self-Reported Pain in Male and Female Iraq/Afghanistan-Era Veterans: Associations with Psychiatric Symptoms and Functioning

Naylor¹,

Wagner

Brancu

et al. 2017

Pain Med

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“…The co-occurrence of sleep disturbances and mental health symptoms with chronic pain represent an exponential increase in pain and suffering. Estimates suggest that up to 50% of individuals with chronic pain have depression, with chronic pain exacerbating depression and depression increasing pain severity and functional impairment (Banks & Kerns, 1996; Kroenke et al, 2011; Outcalt et al, 2014). Sleep difficulties are also common among patients with chronic pain, with up to 89% of patients reporting at least one sleep complaint and 53% of patients attending pain clinics presenting with clinically significant insomnia (McCracken & Iverson, 2002; Smith, Huang, & Manber, 2005; Tang, Wright, & Salkovskis, 2007).…”

mentioning

confidence: 99%

The bidirectional relationship between sleep complaints and pain: Analysis of data from a randomized trial.

Koffel¹,

Kroenke²,

Bair³

et al. 2016

Health Psychology

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115

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Objective The goal of this study was to examine the bidirectional relationship of sleep and pain to determine if changes in sleep complaints over the course of a chronic pain treatment trial predict pain outcomes and vice versa, controlling for changes in depression and anxiety. Methods Data were analyzed from a 12-month randomized controlled trial that tested the effectiveness of a collaborative care intervention for Veterans with chronic musculoskeletal pain. Participants were 250 Veterans from 5 primary care clinics in a Veteran Affairs (VA) medical center. Measures of pain, sleep, and depression/anxiety symptoms were collected at baseline, 3 months, and 12 months. Factor analysis was used to clarify the boundaries of these domains, and structural equation modeling was used to examine if changes in sleep complaints and depression/anxiety during the trial predicted pain at the end of the trial, controlling for covariates. An alternative model was also tested in which changes in pain predicted sleep complaints. Results Changes in sleep complaints at 3 months significantly predicted changes in pain at 12 months (standardized path coefficient of .29, p < .001). To a lesser extent, changes in pain predicted changes in sleep (standardized path coefficient of .15, p < .05). Changes in depression/anxiety did not significantly predict changes in pain or sleep. There was also evidence of differential relations of specific sleep complaints with pain. Conclusions This work helps to further disentangle the complex relationship between pain and sleep. This bidirectional relationship may need to be considered to improve pain outcomes.

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

Cited by 67 publications

References 59 publications

Trends in Opioid Use Disorder Diagnoses and Medication Treatment Among Veterans With Posttraumatic Stress Disorder

Trends in Opioid Use Disorder Diagnoses and Medication Treatment Among Veterans With Posttraumatic Stress Disorder

Self-Reported Pain in Male and Female Iraq/Afghanistan-Era Veterans: Associations with Psychiatric Symptoms and Functioning

The bidirectional relationship between sleep complaints and pain: Analysis of data from a randomized trial.

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