Exploring the Role of Insomnia in the Relation Between PTSD and Pain in Veterans with Polytrauma Injuries

Lang, Katie; Veazey-Morris, Katherine; Andrasik, Frank

doi:10.1037/e533652013-503

Cited by 6 publications

(13 citation statements)

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“…The contribution of pain and sleep medications in these models likely reflects the underlying need to treat the underlying problem. 58,59 Although previous research has documented a high prevalence of sleep disturbances and pain co-occurring in Veterans with TBI and with PTSD, 37,45,60 to our knowledge, previous research has not yet demonstrated how the comorbidity of TBI and PTSD can exacerbate or influence the persistence of these sequelae more than 10 years postinjury. Collectively, our results suggest that TBI and PTSD contribute independently to sleep disturbances and current pain intensity and that Participants self-reported (A) photosensitivity and (B) phonosensitivity scores (0 to 4, higher = greater sensitivity).…”

Section: Discussionmentioning

confidence: 99%

“…For instance, Lang and colleagues found that in Veterans with TBI, PTSD, and pain (ie, the polytrauma clinical triad), insomnia was a significant mediator of both pain severity and pain interference. 45 Conversely, improving sleep quality in patients with TBI and/or PTSD can ameliorate pain and thereby improve the efficacy of rehabilitative strategies. 31,46 Understanding the link between these disorders and sleep disturbances is therefore highly relevant and important for developing more effective treatment options for Veterans.…”

Section: Increased Sleep Disturbances and Pain In Veterans With Comormentioning

confidence: 99%

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Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

Balba

Elliott

Weymann

et al. 2018

Journal of Clinical Sleep Medicine

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Study Objectives: Veterans are at an increased risk for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), both of which are associated with sleep disturbances and increased pain. Furthermore, sleep disturbances and pain are reciprocally related such that each can exacerbate the other. Although both TBI and PTSD are independently linked to sleep disturbances and pain, it remains unclear whether Veterans with comorbid TBI+PTSD show worse sleep disturbances and pain compared to those with only TBI or PTSD. We hypothesized that sleep and pain would be worse in Veterans with comorbid TBI+PTSD compared to Veterans with only TBI or PTSD. Methods: Veterans (n = 639) from the VA Portland Health Care System completed overnight polysomnography and self-report questionnaires. Primary outcome variables were self-reported sleep disturbances and current pain intensity. Participants were categorized into four trauma-exposure groups: (1) neither: without TBI or PTSD (n = 383); (2) TBI: only TBI (n = 67); (3) PTSD: only PTSD (n = 126); and (4) TBI+PTSD: TBI and PTSD (n = 63). Results: The PTSD and TBI+PTSD groups reported worse sleep compared to the TBI and neither groups. The TBI+PTSD group reported the greatest pain intensity compared to the other groups. Conclusions: These data suggest sleep and pain are worst in Veterans with TBI and PTSD, and that sleep is similarly impaired in Veterans with PTSD despite not having as much pain. Thus, although this is a complex relationship, these data suggest PTSD may be driving sleep disturbances, and the added effect of TBI in the comorbid group may be driving pain in this population. stress disorder (PTSD). Among the most prevalent, persistent, and debilitating sequelae in both TBI and PTSD are sleep disturbances and increased pain. Importantly, sleep disturbances and pain also share a reciprocal relationship such that increases in either can independently exacerbate the other. [4][5][6][7] It has been estimated that > 50% of people with TBI experience sleep disturbances, 8-10 including insomnia, 11 hypersomnia, 8 obstructive sleep apnea (OSA), 9 and circadian rhythm sleep disorders. 9,12 Furthermore, current evidence suggests these sleep disturbances can persist for several years postinjury. 13 Sleep disturbances are also a hallmark feature of PTSD BRIEF SUMMARY Current Knowledge/Study Rationale: Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are common in Veterans and are independently associated with sleep disturbances and pain, both of which can exacerbate the other and impede rehabilitation. Understanding the relationship between TBI, PTSD, sleep, and pain will help improve treatment and rehabilitation in this vulnerable population. Study Impact: This study demonstrates that Veterans with PTSD and with both PTSD and TBI experience more sleep disturbances, but those with TBI and PTSD report significantly greater current pain intensity. These data help in the limited understanding of how Veterans with comorbid TBI and PTSD differ from Veteran...

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Section: Discussionmentioning

confidence: 99%

Section: Increased Sleep Disturbances and Pain In Veterans With Comormentioning

confidence: 99%

Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

Balba

Elliott

Weymann

et al. 2018

Journal of Clinical Sleep Medicine

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“…This finding is consistent with growing evidence that PTSD and sleep disorders exhibit significant overlap and may exacerbate each other. For example, veterans with PTSD and obstructive sleep apnea report worse quality of life than those with PTSD alone (Lettieri, Williams, & Collen, ) and in veterans with TBI and PTSD, the presence of insomnia is associated with greater PTSD severity (Lang, Veazey‐Morris, & Andrasik, ). In a study of 659 soldiers returning from deployment in Iraq, greater insomnia at 4 months postdeployment was a significant predictor of increased PTSD symptoms at 12 months postdeployment (Wright et al., ).…”

Section: Discussionmentioning

confidence: 99%

Predictors of PTSD Symptom Change Among Outpatients in the U.S. Department of Veterans Affairs Health Care System

Sripada

Pfeiffer

Rampton

et al. 2017

Journal of Traumatic Stress

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Although the U.S. Department of Veterans Affairs (VA) has prioritized care for posttraumatic stress disorder (PTSD), many patients with PTSD remain symptomatic. Patterns of PTSD symptom change are not well understood. Thus, the current study was designed to categorize and investigate potential predictors of symptom trajectories in patients with PTSD. The sample comprised 2,237 VA patients who were diagnosed with PTSD in 2013 and completed at least 4 PTSD Checklist (PCL) assessments over 12 weeks. Latent trajectory analysis was used to identify latent classes of patients based on PCL scores. Based on model fit indices, 3 trajectories were identified. Compared to patients in the mild-improving trajectory (21.9%), those in the severe-stable trajectory (34.3%) were more likely to be male, relative risk ratio (RRR) = 1.48, 95% CI [1.08, 2.02]; non-White, RRR = 1.77, 95% CI [1.33, 2.35]; Hispanic, RRR = 2.07, 95% CI [1.40, 3.04]; and have comorbid depression, RRR = 1.58, 95% CI [1.25, 1.99]. Compared to patients in the moderate-improving trajectory (43.8%), those in the severe-stable trajectory were more likely to have sleep disorders, RRR = 1.25, 95% CI [1.01, 1.55]. Our findings suggest that male veterans, minority veterans, and veterans with certain comorbid conditions may be less likely to achieve improved PTSD symptoms. Targeted efforts are needed to improve outcomes for PTSD patients on nonremitting trajectories and to improve the consistency of PTSD assessment across the VA health care system.

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“…24,25 Veterans represent 7% of the population and are similar to the Medicaid population in that they tend to have less income and education, are predominately male, and are more disabled than the general population. 26 Veterans have high need for management of chronic pain and symptoms of anxiety or depression, [27][28][29] conditions for which some types of CIH might be effective.…”

Section: Introductionmentioning

confidence: 99%

Complementary and Integrated Health Approaches: What Do Veterans Use and Want

2019

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OBJECTIVES: Non-pharmacological treatment options for common conditions such as chronic pain, anxiety, and depression are being given increased consideration in healthcare, especially given the recent emphasis to address the opioid crisis. One set of non-pharmacological treatment options are evidence-based complementary and integrative health (CIH) approaches, such as yoga, acupuncture, and meditation. The Veterans Health Administration (VHA), the nation's largest healthcare system, has been at the forefront of implementing CIH approaches, given their patients' high prevalence of pain, anxiety, and depression. We aimed to conduct the first national survey of veterans' interest in and use of CIH approaches. METHODS: Using a large national convenience sample of veterans who regularly use the VHA, we conducted the first national survey of veterans' interest in, frequency of and reasons for use of, and satisfaction with 26 CIH approaches (n = 3346, 37% response rate) in July 2017. RESULTS: In the past year, 52% used any CIH approach, with 44% using massage therapy, 37% using chiropractic, 34% using mindfulness, 24% using other meditation, and 25% using yoga. For nine CIH approaches, pain and stress reduction/relaxation were the two most frequent reasons veterans gave for using them. Overall, 84% said they were interested in trying/learning more about at least one CIH approach, with about half being interested in six individual CIH approaches (e.g., massage therapy, chiropractic, acupuncture, acupressure, reflexology, and progressive relaxation). Veterans appeared to be much more likely to use each CIH approach outside the VHA vs. within the VHA. CONCLUSIONS: Veterans report relatively high past-year use of CIH approaches and many more report interest in CIH approaches. To address this gap between patients' level of interest in and use of CIH approaches, primary care providers might want to discuss evidence-based CIH options to their patients for relevant health conditions, given most CIH approaches are safe.

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Exploring the Role of Insomnia in the Relation Between PTSD and Pain in Veterans with Polytrauma Injuries

Cited by 6 publications

References 0 publications

Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

Predictors of PTSD Symptom Change Among Outpatients in the U.S. Department of Veterans Affairs Health Care System

Complementary and Integrated Health Approaches: What Do Veterans Use and Want

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