Chronic Pain in Veterans and Servicemembers with a History of Mild Traumatic Brain Injury: A Systematic Review

O’Neil ME, Carlson KF, Holmer HK, Ayers CK, Morasco BJ, Kansagara D, Kondo K. Chronic Pain in Veterans and Servicemembers with a History of Mild Traumatic Brain Injury: A Systematic Review. 2020 Aug 1.

AIM: We conducted a systematic review on the prevalence of chronic pain in Veterans and Servicemembers (SMs) with a history of mild traumatic brain injury (mTBI), the risk of suicide, and the benefits and harms of interventions to treat chronic pain in this population. METHODS: We searched electronic databases, clinical trial registries, and reference lists through February 2020. For intervention studies, we included only randomized and non-randomized controlled trials. We abstracted study design, sample size, setting, population characteristics, inclusion and exclusion criteria, operationalizations of key variables, and results. Independent dual assessment of study’s full text and quality ratings were agreed upon by consensus using prespecified criteria. RESULTS: 27 articles (26 studies) reported chronic pain prevalence estimates, 1 study examined suicide outcomes, and 3 studies examined interventions for the treatment of chronic pain in Veterans and SMs with a history of mTBI. Across studies, the prevalence of chronic pain among this population varied widely but, overall, was high. Head pain (, headaches or migraines; 23 studies) was the most common, followed by back (10), and arm, leg, and/or joint pain (9). Four articles reported the use of pain medication as an indicator of chronic pain. The 1 study examining suicide outcomes found that compared to those with relatively low rates of pain and other sensory diagnoses, Veterans with high post-concussive symptoms, and mental health and pain comorbidities were more likely to have been diagnosed with suicidal ideation or attempt. The 3 intervention studies were small and provide insufficient evidence for rTMS (2 RCTs) and Flexyx Neurotherapy System, a type of neurotherapy. CONCLUSION: Chronic pain in Veterans and SMs with a history of mTBI is common. Precise prevalence estimates are hampered by heterogeneity. There is very little current research of suicide-related outcomes in, and interventions for, this population. More research is needed.