Comorbid Chronic Pain and Posttraumatic Stress Disorder Among Veterans: Approaches to Care.

Pratt, Van Tiem, Lund, Johnson, Steffensmeier, Ball, Thomas, Mengeling, Norman, Driscoll, Garvin, Hart, Hadlandsmyth. Comorbid Chronic Pain and Posttraumatic Stress Disorder Among Veterans: Approaches to Care. Military medicine. 2025 Apr 11 DOI: 10.1093/milmed/usaf118.

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Abstract:

INTRODUCTION: The aim is to elucidate approaches to care for comorbid chronic pain and PTSD (CP + PTSD) in the Veterans Administration (VA). These conditions are co-magnifying and highly comorbid but traditionally treated in separate clinical settings. MATERIALS AND METHODS: This multimethod analysis examined care for CP + PTSD via administrative data analyses and qualitative interviews of VA-served veterans. RESULTS: All participants with diagnoses of CP + PTSD in 2021 were identified using VA administrative data (N  =  456,544). Visits during the following year (2022) coded for chronic pain, PTSD, or both were analyzed. Qualitative interview participants (N  =  22) were recruited, screened, consented, and enrolled in 2023. Administrative findings demonstrated that clinical settings differed where CP and PTSD were treated. For PTSD, 90.7% of visits occurred in the mental health service line, whereas for CP, visits occurred across a range of settings outside mental health (e.g., primary care, rehabilitative services, and surgical services). A small percentage of visits (4.8%) were coded for both CP + PTSD, indicating possible combined care. In qualitative interviews, participants acknowledged that CP and PTSD symptoms may impact one another but noted that the health care they received for these 2 conditions was typically siloed. Participants also identified barriers that would need to be addressed before a fully integrated coordinated care model could be implemented. CONCLUSIONS: Veterans reported interest in coordinated treatment for CP + PTSD; however, the provision of CP + PTSD care provided across different service lines may pose challenges to optimizing care coordination.