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:10.1097/htr.0b013e31829c85d0

Cited by 43 publications

(33 citation statements)

References 58 publications

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“…For example, one recent study found that poor sleep quality was associated with PTSD, panic disorder, depression, suicidal ideation, and risky drinking behavior in Iraq/Afghanistan Veterans (Swinkels et al, 2013). Other studies have reported similar poor outcomes in Veterans with sleep difficulties including lower quality of life and more severe fatigue, pain, PTSD, and depressive symptoms compared to those without sleep difficulties (Lang, Veazey-Morris, & Andrasik, 2014; Wallace et al, 2011). Ribeiro and colleagues (2012) reported an association between insomnia symptoms and suicidal ideation in a sample of 311 military personnel.…”

Section: Sleep Disturbances and Ptsdmentioning

confidence: 66%

Sleep disturbances, TBI and PTSD: Implications for treatment and recovery

Gilbert

Kark

Gehrman

et al. 2015

Clinical Psychology Review

117

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Post-Traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), and sleep problems significantly affect recovery and functional status in military personnel and Veterans returning from combat. Despite recent attention, sleep is understudied in the Veteran population. Few treatments and rehabilitation protocols target sleep, although poor sleep remains at clinical levels and continues to adversely impact functioning even after the resolution of PTSD or mild TBI symptoms. Recent developments in non-pharmacologic sleep treatments have proven efficacious as stand-alone interventions and have potential to improve treatment outcomes by augmenting traditional behavioral and cognitive therapies. This review discusses the extensive scope of work in the area of sleep as it relates to TBI and PTSD, including pathophysiology and neurobiology of sleep; existing and emerging treatment options; as well as methodological issues in sleep measurements for TBI and PTSD. Understanding sleep problems and their role in the development and maintenance of PTSD and TBI symptoms may lead to improvement in overall treatment outcomes while offering a non-stigmatizing entry in mental health services and make current treatments more comprehensive by helping to address a broader spectrum of difficulties.

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Section: Sleep Disturbances and Ptsdmentioning

confidence: 66%

Sleep disturbances, TBI and PTSD: Implications for treatment and recovery

Gilbert

Kark

Gehrman

et al. 2015

Clinical Psychology Review

117

View full text Add to dashboard Cite

show abstract

“…Pain is among the most frequent symptoms described by veterans, and has been documented as a prevalent clinical problem in the recent generation of U. S. veterans returning from Iraq and Afghanistan (Lippa et al., ). Rates of reported current pain (of at least a mild level) were found in 47% (Gironda, Clark, Massengale, & Walker, ) to 89.8% (Lang, Veazey‐Morris, & Andrasik, ) of those returning from Iraq and Afghanistan. Chronic pain diagnosis, pain that has been present most of the time for at least 3 to 6 months (Mersky & Bogduk, ), has been found in 48.4% (Kerns, Otis, Rosenberg, & Reid, ).…”

mentioning

confidence: 99%

Sleep Quality and Reexperiencing Symptoms of PTSD Are Associated With Current Pain in U.S. OEF/OIF/OND Veterans With and Without mTBIs

Powell

Corbo

Fonda

et al. 2015

Journal of Traumatic Stress

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Pain, a debilitating condition, is frequently reported by U.S. veterans returning from Afghanistan and Iraq. This study investigated how commonly reported clinical factors were associated with pain and whether these associations differed for individuals with a history of chronic pain. From the Boston metropolitan area, 171 veterans enrolled in the Veterans Affairs Center of Excellence were assessed for current posttraumatic stress disorder (PTSD) symptom severity, current mood and anxiety diagnoses, lifetime traumatic brain injury, combat experiences, sleep quality, and alcohol use. Hierarchical regression models were used to determine the association of these conditions with current pain. Average pain for the previous 30 days, assessed with the McGill Pain Questionnaire, was 30.07 out of 100 (SD = 25.43). Sleep quality, PTSD symptom severity, and alcohol use were significantly associated with pain (R(2) = .24), as were reexperiencing symptoms of PTSD (R(2) = .25). For participants with a history of chronic pain (n = 65), only PTSD symptoms were associated with pain (R(2) = .19). Current pain severity was associated with increased PTSD severity (notably, reexperiencing symptoms), poor sleep quality, and increased alcohol use. These data support the hypothesis that PTSD symptoms influence pain, but suggest that problems with sleep and alcohol use may exacerbate the relationship.

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“…Personnel that served in OEF/OIF who return with co-occurring mild TBI and PTSD often have other comorbid conditions, including pain and sleep disturbances not measured in this study. 68-70 Additionally, we do not capture those personnel who may have separated from the Armed Forces or been dishonorably discharged within the past year. All of these omitted variables could be explored in future studies.…”

Section: Discussionmentioning

confidence: 99%

Combat-Acquired Traumatic Brain Injury, Posttraumatic Stress Disorder, and Their Relative Associations With Postdeployment Binge Drinking

Adams¹,

Larson²,

Corrigan³

et al. 2016

Journal of Head Trauma Rehabilitation

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Objective To examine whether experiencing a traumatic brain injury (TBI) on a recent combat deployment was associated with postdeployment binge drinking, independent of posttraumatic stress disorder (PTSD). Methods Using the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel, an anonymous survey completed by 28,546 personnel, the study sample included 6,824 personnel who had a combat deployment in the past year. Path analysis was used to examine whether PTSD accounted for the total association between TBI and binge drinking. Main Measures The dependent variable, binge drinking days, was an ordinal measure capturing the number of times personnel drank 5+ drinks on one occasion (4+ for women) in the past month. TBI-level captured the severity of TBI after a combat injury event exposure: TBI-AC (altered consciousness only), TBI-LOC≤20 (loss of consciousness up to 20 minutes), and TBI-LOC>20 (loss of consciousness greater than 20 minutes). APTSD positive screen relied on the standard diagnostic cutoff of 50+ on the PCL-C. Results The final path model found that while the direct effect of TBI (0.097) on binge drinking was smaller than that of PTSD (0.156), both were significant. Almost 70% of the total effect of TBI on binge drinking was from the direct effect; only 30% represented the indirect effect through PTSD. Conclusion Further research is needed to replicate these findings and to understand the underlying mechanisms that explain the relationship between TBI and increased postdeployment drinking.

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

Cited by 43 publications

References 58 publications

Sleep disturbances, TBI and PTSD: Implications for treatment and recovery

Sleep disturbances, TBI and PTSD: Implications for treatment and recovery

Sleep Quality and Reexperiencing Symptoms of PTSD Are Associated With Current Pain in U.S. OEF/OIF/OND Veterans With and Without mTBIs

Combat-Acquired Traumatic Brain Injury, Posttraumatic Stress Disorder, and Their Relative Associations With Postdeployment Binge Drinking

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