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Pain and Psychological Outcomes in OEF/OIF Veterans with Comorbid Musculoskeletal Pain and PTSD: Analysis of Baseline Data from a Randomized Trial
Outcalt SD, Xizomei P, Ang D, Sargent C, Slaven J, Bair MJ. Pain and Psychological Outcomes in OEF/OIF Veterans with Comorbid Musculoskeletal Pain and PTSD: Analysis of Baseline Data from a Randomized Trial. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 17; National Harbor, MD.
To compare pain and associated psychological outcomes in OEF/OIF veterans with and without posttraumatic stress disorder.
We analyzed cross-sectional data from the Evaluation of Stepped Care for Chronic Pain (ESCAPE) trial to compare chronic pain outcomes among veterans with and without PTSD. Participants included 241 veterans with at least three months of musculoskeletal pain. Face-to-face interviews were conducted at the Roudebush VAMC. Our analysis examined several scales of pain severity, pain interference, and associated pain and psychological outcomes. Comparison groups were categorized according to a Posttraumatic Stress Disorder Checklist (PCL-C) score of 41, a validated cutoff and minimum score to meet DSM-IV diagnostic criteria for PTSD.
More than three-quarters of the sample (78%) screened positive for PTSD and 36.2% of those scored in diagnostic ranges for PTSD. Veterans with PTSD, compared to those without PTSD, had more severe pain (54.6 vs. 47.9 on Graded Chronic Pain Scale ), greater pain-related disability (15.9 vs. 13.1 on Roland Disability Scale), higher pain interference (6.9 vs. 4.8 on Brief Pain Inventory), more pain catastrophizing (28.8 vs. 19.0 on Pain Catastrophizing Scale), lower pain self-efficacy (27.5 vs. 19.0 on Pain Self Efficacy Scale), greater pain centrality (36.9 vs. 30.4 on Centrality of Pain Scale), and higher depression (16.5 vs. 9.3 on PHQ-9 ) and anxiety (24.8 vs. 13.5 on PHQ anxiety scale; all comparisons p < .0001).
We found a strong association between chronic pain and PTSD among OEF/OIF veterans. These findings suggest a more intense and disabling chronic pain experience for newly returning veterans also living with PTSD. Notably, a large majority of this sample screened positive for PTSD, over a third of whom were identified with clinically significant PTSD symptoms.
These results contribute to our understanding of the link between chronic pain and PTSD, which are highly prevalent diagnoses within VHA. Our findings emphasize the combined adverse effects of living with both conditions and highlight the importance of assessing and treating the two in an integrated fashion. Ultimately, we hope this study contributes toward improved services for these veterans who are dually suffering with both physical and emotional pain.