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Treatment of comorbid pain and PTSD in returning veterans: a collaborative approach utilizing behavioral activation.

Plagge JM, Lu MW, Lovejoy TI, Karl AI, Dobscha SK. Treatment of comorbid pain and PTSD in returning veterans: a collaborative approach utilizing behavioral activation. Pain medicine (Malden, Mass.). 2013 Aug 1; 14(8):1164-72.

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OBJECTIVE: We explore preliminary clinical effectiveness and feasibility of an intervention utilizing collaborative care components and behavioral activation (BA) to treat comorbid chronic pain and posttraumatic stress disorder (PTSD). DESIGN: Descriptive, including pre- and posttreatment assessment results. SETTING: Portland Veterans Affairs Medical Center. PARTICIPANTS: Fifty-eight Iraq and Afghanistan veterans with chronic pain and PTSD symptoms. INTERVENTIONS: Veterans participated in a biopsychosocial evaluation and up to eight BA sessions using a collaborative approach involving primary care, mental health, and other clinicians. A physiatrist assisted the psychologist in providing recommendations to primary care providers. OUTCOME MEASURES: Participants were administered pre- and posttreatment measures of PTSD, pain severity, pain interference, mental health, quality of life, satisfaction, and global ratings of change with the purpose of assessing progress and improving quality. RESULTS: Of the 58 participants, 30 completed treatment. Common recommendations included physical therapy and exercise programs, pain medication or pain medication adjustments, and additional diagnostic workups, such as imaging. Participants who completed the program showed significant improvements on measures of PTSD, pain severity, and pain interference. Improvements were also evident on measures of mental health and quality of life. Overall, participants were satisfied with the program, and on average reported feeling "somewhat better." CONCLUSIONS: These findings suggest that a collaborative approach that includes BA is feasible and a potentially effective treatment for comorbid chronic pain and PTSD.

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