Prevalence and Costs of Co-occurring Traumatic Brain Injury With and Without Psychiatric Disturbance and Pain Among Afghanistan and Iraq War Veteran VA Users

Taylor, Brent C.; Hagel, Emily; Carlson, Kathleen F.; Cifu, David X.; Cutting, Andrea; Bidelspach, Douglas E.; Sayer, Nina A.

doi:10.1097/mlr.0b013e318245a558

Cited by 294 publications

(187 citation statements)

References 23 publications

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“…This would agree with findings in other anxiety disorders. However, the majority of patients seen clinically and recruited into the study had both PTSD and mTBI, which is consistent with the observations of other investigators (Carlson et al, 2011;Taylor et al, 2012). Thus, the question is whether combat Veterans with PTSD (most with mTBI as well, but some with PTSD-only) will show deficits in error monitoring as indexed by the ERN.…”

Section: Introductionsupporting

confidence: 83%

Intact error monitoring in combat Veterans with post-traumatic stress disorder

Swick

Honzel

Turken

2015

Psychiatry Research: Neuroimaging

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The error-related negativity (ERN) is a neuroelectric signature of performance monitoring during speeded response time tasks. Previous studies indicate that individuals with anxiety disorders show ERN enhancements that correlate with the degree of clinical symptomology. Less is known about the error monitoring system in post-traumatic stress disorder (PTSD). PTSD is characterized by impairments in the regulation of fear and other emotional responses, as well as deficits in maintaining cognitive control. Here, combat Veterans with PTSD were compared to control Veterans in two different versions of the flanker task (n=13 or 14 per group). Replicating and extending previous findings, PTSD patients showed an intact ERN in both experiments. In addition, task performance and error compensation behavior were intact. Finally, ERN amplitude showed no relationship with self-reported PTSD, depression, or post-concussive symptoms. These results suggest that error monitoring represents a relative strength in PTSD that can dissociate from cognitive control functions that are impaired, such as response inhibition and sustained attention. A healthy awareness of errors in external actions could be leveraged to improve interoceptive awareness of emotional state. The results could have positive implications for PTSD treatments that rely on self-monitoring abilities, such as neurofeedback and mindfulness training.

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Section: Introductionsupporting

confidence: 83%

Intact error monitoring in combat Veterans with post-traumatic stress disorder

Swick

Honzel

Turken

2015

Psychiatry Research: Neuroimaging

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“…Likewise, our data in patients with spasticity concurs with previous studies that reported prevalence of pain in stroke to be 19-75%, [26][27][28] 53% in MS, 29 64.9% in SCI 30 and 70% in brain injured patients. 31 The Cochrane Collaboration Systematic Review 32 reported a decrease in shoulder pain after injection of BoNTA; but in contrast, our study provides data on the prevalence of pain at any site in the body (not limited to shoulder pain) in patients experiencing spasticity due to various etiologies. Thus, our study results provide unique data to help understand patient perception of pain within the context of the experience of spasticity.…”

Section: Discussionmentioning

confidence: 63%

Relationship Between Botulinum Toxin, Spasticity, and Pain: a Survey of Patient Perception

Shaikh

Phadke

Ismail

et al. 2015

Can. J. Neurol. Sci.

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Objective: To assess the prevalence of pain in adults with spasticity and to assess the association between the subjective experience of pain and spasticity. Design: Cross-sectional study. Setting: outpatient spasticity management clinic of a rehabilitation centre. Patients: Patients with upper motor neuron lesions and spasticity (n = 131) were recruited. Methods: We assessed pain intensity and location, relationship between spasticity and pain perception, and perception of pain relief from botulinum toxin type-A (BoNTA) injections. Main outcome measures: Pain perception rated on a 10-point numerical rating scale and pain quality. Results: 65% of the patients with spasticity reported presence of pain and 60% described it as an aching pain. More patients reported pain with movement (34%) compared to rest (21%). There was a statistically poor correlation between the severity of pain and spasticity (r = 0.16; p > 0.05). Most patients (80%) believed that their pain was related to spasticity and 62% reported that BoNTA injections decreased their pain. Conclusions: The high incidence of pain noted within our sample suggests that physicians may have to consider pain management as part of spasticity treatment. Participants reported that their pain was related to their spasticity, and that it decreased after BoNTA treatment. Further study is needed to explore the relationships between objective measures of spasticity and pain.RÉSUMÉ: Relation entre la toxine botulique, la spasticité et la douleur : une enquête sur la perception des patients. Objectif: Le but de l'étude était de déterminer la prévalence de la douleur chez des adultes souffrant de spasticité et d'étudier l'association entre l'expérience subjective de la douleur et la spasticité. Devis de l'étude: Il s'agit d'une étude transversale. Contexte: Cette étude a été réalisée auprès de patients fréquentant une clinique dédiée au traitement de la spasticité dans un centre de réadaptation. Patients: Des patients atteints de lésions du neurone moteur supérieur et de spasticité ont été recrutés (n = 131). Méthode: Nous avons évalué l'intensité et la localisation de la douleur, la relation entre la spasticité et la perception de la douleur ainsi que la perception du soulagement de la douleur suite à des injections de toxine botulique de type A (BoNTA). Principaux critères d'évaluation: Les critères utilisés étaient la perception de la douleur évaluée sur une échelle numérique de 10 points et la qualité de la douleur. Résultats: Soixante-cinq pour cent des patients présentant de la spasticité ont rapporté la présence de douleur et 60% l'ont décrite comme une douleur sourde. Plus de patients ont rapporté de la douleur au mouvement (34%) qu'au repos (21%). La corrélation entre la sévérité de la douleur et la spasticité était faible au point de vue statistique (r = 0,16 ; p > 0,05). La plupart des patients (80%) croyaient que leur douleur était reliée à la spasticité et 62% rapportaient que les injections de BoNTA diminuaient la douleur. Conclusions: L'incidence ...

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“…This carries an inherent risk of false positives and false negatives, as well as sampling differences [16]. The gold standard for TBI diagnosis is a clinical interview and evaluation with a specialist (as opposed to self-report surveys, imaging, or laboratory testing) because of the difficulty obtaining accurate information on TBI history through brief self-report measures and no defined physiologic or biologic marker [7]. Self-report measures may overestimate the rate of TBI compared with clinical assessment, just as they have been found to overestimate the rate of PTSD relative to gold standard interviews [17][18].…”

Section: Discussionmentioning

confidence: 99%

“…A 2009 national sample of all OIF/OEF Veterans who received VA care during that year revealed that 6.7 percent had been diagnosed with TBI [7]. In this TBI group, 89 percent had a concomitant mental health disorder, with the most frequent diagnosis being PTSD (73%); 70 percent had a concomitant pain disorder; and 54 percent had both PTSD and pain (the polytrauma triad).…”

Section: Introductionmentioning

confidence: 99%

Traumatic brain injury, posttraumatic stress disorder, and pain diagnoses in OIF/OEF/OND Veterans

Cifu¹,

et al. 2013

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Abstract-To identify the prevalence of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain in Veterans from Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OIF/OEF/OND), Veterans who received any inpatient or outpatient care from Veterans Health Administration (VHA) facilities from 2009 to 2011 were studied. A subset of Veterans was identified who were diagnosed with TBI, PTSD, and/or pain (head, neck, or back) as determined by their International Classification of Diseases-9th Revision-Clinical Modification codes. Between fiscal years 2009 and 2011, 613,391 Veterans accessed VHA services at least once (age: 31.9 +/-9.6 yr). TBI diagnosis in any 1 year was slightly less than 7%. When data from 3 years were pooled, 9.6% were diagnosed with TBI, 29.3% were diagnosed with PTSD, and 40.2% were diagnosed with pain. The full polytrauma triad expression (TBI, PTSD, and pain) was diagnosed in 6.0%. Results show that increasing numbers of Veterans from OIF/ OEF/OND accessed VHA over a 3 year period. Among those with a TBI diagnosis, the majority also had a mental health disorder, with approximately half having both PTSD and pain. While the absolute number of Veterans increased by over 40% from 2009 to 2011, the proportion of Veterans diagnosed with TBI and the high rate of comorbid PTSD and pain in this population remained relatively stable.

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Prevalence and Costs of Co-occurring Traumatic Brain Injury With and Without Psychiatric Disturbance and Pain Among Afghanistan and Iraq War Veteran VA Users

Cited by 294 publications

References 23 publications

Intact error monitoring in combat Veterans with post-traumatic stress disorder

Intact error monitoring in combat Veterans with post-traumatic stress disorder

Relationship Between Botulinum Toxin, Spasticity, and Pain: a Survey of Patient Perception

Traumatic brain injury, posttraumatic stress disorder, and pain diagnoses in OIF/OEF/OND Veterans

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