Persistent Pain and Comorbidity Among Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans

Higgins, Diana M.; Kerns, Robert D.; Brandt, Cynthia; Haskell, Sally G.; Bathulapalli, Harini; Gilliam, Wesley P; Goulet, Joseph L.

doi:10.1111/pme.12388

Cited by 150 publications

(119 citation statements)

References 28 publications

Supporting

Mentioning

110

Contrasting

Order By: Relevance

“…In particular, they had the highest adjusted odds of being in the combined back and arthritis/joint pain group. This is consistent with recent Veteran data demonstrating that those with persistent pain were more likely to report comorbid conditions, including diagnoses of mood disorders, PTSD, substance use disorders, anxiety disorders, and traumatic brain injury; they were also more likely to have a BMI consistent with overweight/obesity [33]. Other research has shown that those with multiple painful conditions have a number of additional medical and mental health comorbidities, along with higher burden of illness and cost of care [34].…”

Section: Discussionsupporting

confidence: 91%

“…In the current study, patients with comorbid mental health conditions, including depression and PTSD, were more likely than those without the conditions to report being in the groups with pain (the back pain only, arthritis/joint pain only, and both back and arthritis/joint pain groups) relative to the "no pain" group, a finding that is consistent with existing data describing Veterans with chronic pain [33,[35][36][37][38]. However, those patients reporting comorbid schizophrenia were less likely to report back pain or arthritis/joint pain.…”

Section: Discussionsupporting

confidence: 87%

See 1 more Smart Citation

Prevalence and correlates of painful conditions and multimorbidity in national sample of overweight/obese Veterans

Higgins

Buta²,

Dorflinger³

et al. 2016

J Rehabil Res Dev

Self Cite

View full text Add to dashboard Cite

Abstract-Chronic pain and overweight/obesity are prevalent public health concerns and occur at particularly high rates among Veterans. This study examined the prevalence and correlates of two common painful conditions (back pain and arthritis/ joint pain) among overweight/obese Veterans in Veterans Health Administration (VHA) care. Participants (N = 45,477) completed the MOVE!23, a survey intended to tailor treatment for Veterans in VHA's MOVE! weight-management program. Overall, 72% of the sample reported painful conditions, with 10% reporting back pain, 26% reporting arthritis/joint pain, and 35% reporting both. We used multinomial logistic regression with "no pain" as the reference category to examine the association between painful conditions and participant characteristics. After multivariable adjustment, female Veterans had higher odds of reporting arthritis/joint pain and combined back and arthritis/ joint pain than no pain. Participants with higher body mass index had higher odds of reporting arthritis/joint pain and both back and arthritis/joint pain. The likelihood of painful conditions was higher in Veterans with comorbidities (hypertension, hyperlipidemia, lung disease, depression, anxiety, or posttraumatic stress disorder) and generally increased with the number of comorbidities reported (i.e., 5 or more). Overweight/obese Veterans frequently report painful conditions and, among those with pain, often have multiple comorbidities. These factors may increase the complexity of clinical management and necessitate refinements to weight-management programs.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

Prevalence and correlates of painful conditions and multimorbidity in national sample of overweight/obese Veterans

Higgins

Buta²,

Dorflinger³

et al. 2016

J Rehabil Res Dev

Self Cite

View full text Add to dashboard Cite

show abstract

“…Dependence to prescribed painkillers is also specifically studied in American war veterans who may have at the same time combat exposure PTSD and pains that require pharmacological treatment. In those studies, a diagnosis of PTSD or its severity appears as a risk factor of prolonged pain, of opioid use, and of opioid dependence [40][41][42][43]. But on the other hand, a toxic effect of chronic heroin use leading to secondary anxiety disorder is also observed.…”

Section: Opiatesmentioning

confidence: 94%

Anxiety and Substance Use Disorders: Co-occurrence and Clinical Issues

Vorspan

Mehtelli

Dupuy

et al. 2015

Curr Psychiatry Rep

127

View full text Add to dashboard Cite

The co-occurrence of substance use disorders (SUDs) and anxiety disorders has been now well established. This association is frequent and can be explained by three models: the shared vulnerability factors model, the self-medication model, and the substance-induced model. General population epidemiological studies provide strong evidence of the frequency of the association for the most used substances: tobacco, alcohol, cannabis, and to a lesser extent sedatives, opiates, and cocaine. For substances that are less commonly used in the general population, the frequency of the co-occurrence can more precisely be studied in clinical samples. We provide the most recent literature results on the association of SUDs and anxiety, and evidence for one explicative model or the other when available. For substances with sedative properties (alcohol, benzodiazepines, cannabis, opioids), both evidence for a self-medication and for a toxic effect exist. For substances with psychostimulant properties (tobacco, cocaine, and amphetamines), the literature favors the toxic hypothesis to explain the association with anxiety disorders. We give practical steps for the recognition of these dual diagnoses and present therapeutic issues, although the strategies are rarely evidence based.

show abstract

“…Stress and stress-related anxiety could also influence TBI outcome as people who exhibited high levels of acute stress symptoms and anxiety had poor TBI outcome (23). A significant portion of the US military personnel returning from Iraq and Afghanistan battlefields have experienced persistent somatic pain, as well as comorbidity of mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) (24–30). In a logistic regressions study of 2,348 veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) (51% female), Iverson et al (31) reported significant associations between probable TBI, symptomatic anxiety, and symptomatic physical health in both genders.…”

Section: Introductionmentioning

confidence: 99%

Differential Expression of Brain Cannabinoid Receptors between Repeatedly Stressed Males and Females may Play a Role in Age and Gender-Related Difference in Traumatic Brain Injury: Implications from Animal Studies

et al. 2014

View full text Add to dashboard Cite

Inconsistent gender differences in the outcome ofTBI have been reported.The mechanism is unknown. In a recent male animal study, repeated stress followed by TBI had synergistic effects on brain gene expression and caused greater behavioral deficits. Because females are more likely to develop anxiety after stress and because anxiety is mediated by cannabinoid receptors (CBRs) (CB 1 and CB 2 ), there is a need to compare CB 1 and CB 2 expression in stressed males and females. CB 1 and CB 2 mRNA expression was determined in the amygdala, hippocampus, prefrontal cortex (PFC), and hypothalamus of adolescent male and female rats after 3 days of repeated tail-shock stress using qPCR. PFC CB 1 and CB 2 protein levels were determined using Western blot techniques. Both gender and stress had significant effects on brain CB 1 mRNA expression levels. Overall, females showed significantly higher CB 1 and CB 2 mRNA levels in all brain regions than males (p < 0.01). Repeated stress reduced CB 1 mRNA levels in the amygdala, hippocampus, and PFC (p < 0.01, each). A gender × stress interaction was found in CB 1 mRNA level in the hippocampus (p < 0.05), hypothalamus (p < 0.01), and PFC (p < 0.01). Within-sex one-way ANOVA analysis showed decreased CB 1 mRNA in the hippocampus, hypothalamus, and PFC of stressed females (p < 0.01, each) but increased CB 1 mRNA levels in the hypothalamus of stressed males (p < 01).There was a gender and stress interaction in prefrontal CB 1 receptor protein levels (p < 0.05), which were decreased in stressed females only (p < 0.05). Prefrontal CB 2 protein levels were decreased in both male and female animals after repeated stress (p < 0.05, each). High basal levels of CBR expression in young naïve females could protect against TBI damage whereas stress-induced CBR deficits could predict a poor outcome of TBI in repeatedly stressed females. Further animal studies could help evaluate this possibility.

show abstract

Persistent Pain and Comorbidity Among Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans

Cited by 150 publications

References 28 publications

Prevalence and correlates of painful conditions and multimorbidity in national sample of overweight/obese Veterans

Prevalence and correlates of painful conditions and multimorbidity in national sample of overweight/obese Veterans

Anxiety and Substance Use Disorders: Co-occurrence and Clinical Issues

Differential Expression of Brain Cannabinoid Receptors between Repeatedly Stressed Males and Females may Play a Role in Age and Gender-Related Difference in Traumatic Brain Injury: Implications from Animal Studies

Contact Info

Product

Resources

About