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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1114 — Gender Differences in Pain Diagnoses among OEF/OIF Veteran VA Users with Traumatic Brain Injury

Carlson KF, Center for the Study of Chronic, Comorbid Mental and Physical Disorders; Portland VA Medical Center; Taylor BC, and Hagel EM, Center for Chronic Disease Outcomes Research; Minneapolis VA Healthcare System; Kerns RD, Pain Research, Informatics, Medical comorbidities, and Education (PRIME) Center; VA Connecticut Healthcare System; Sayer NA, Center for Chronic Disease Outcomes Research; Minneapolis VA Healthcare System;

Objectives:
This is the first study to address gender differences in pain diagnoses among Veterans with a history of traumatic brain injury (TBI). Our objective was to determine whether certain pain diagnoses are more prevalent in female compared to male OEF/OIF Veteran VA users with TBI.

Methods:
Participants were all OEF/OIF VA users in fiscal year (FY) 2009. We extracted FY2009 demographic and utilization data from administrative datasets. Inpatient and outpatient care files were used to identify diagnoses related to TBI and to head, neck, and back pain, excluding those associated with lab, radiology, or telephone encounters. Descriptive statistics were calculated to compare pain diagnoses by gender and by TBI diagnosis status. Associations between gender and pain diagnoses were estimated using risk ratios adjusted for age, race/ethnicity, and whether Veterans were new VA users in FY2009.

Results:
We identified 327,388 OEF/OIF Veterans who used VA services in 2009; 88% were male and 12% were female. Among females and males, respectively, 3% and 7% received at least one TBI diagnosis and 34% and 33% received one or more pain diagnoses. Back pain was the most prevalent (females, 22%; males, 25%), followed by headache (17%; 11%) and neck pain (7%; 6%). Pain was especially prevalent among Veterans with TBI diagnoses: 78% of females and 70% of males with TBI had pain diagnoses. While prevalence of neck and back pain were similar by gender, headache-related diagnoses were more prevalent among females (61%) than males (47%) with TBI. After controlling for potential confounders, females with TBI were 1.3 times more likely to have headache diagnoses than males with TBI. Gender patterns were similar in OEF/OIF Veterans without TBI diagnoses.

Implications:
Pain diagnoses were highly prevalent among FY2009 OEF/OIF Veteran VA users with TBI diagnoses. Headache diagnoses were more prevalent among females than males, regardless of TBI diagnosis status.

Impacts:
Results emphasize the necessity of pain identification and management for all Veterans with TBI. Headache diagnoses are more prevalent among females than males; however, headaches are highly prevalent among both males and females with TBI and the provision of effective headache services is a priority regardless of gender.


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