The Development of an Integrated Treatment for Veterans with Comorbid Chronic Pain and Posttraumatic Stress Disorder

Otis, John D.; Keane, Terence M.; Kerns, Robert D.; Monson, Candice M.; Scioli, Erica R.

doi:10.1111/j.1526-4637.2009.00715.x

Cited by 154 publications

(118 citation statements)

References 37 publications

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“…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%

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

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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.

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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

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“…Following the work completed by Wagner et al [99] that examined BA as an early intervention for PTSD and depression among physically injured trauma survivors, an integrated treatment approach for Veterans with comorbid PTSD and pain was initiated as a pilot study [103]. Using components of CPT for PTSD and CBT for chronic pain management, Otis et al developed a 12-session integrated treatment for PTSD and chronic pain [103].…”

Section: Discussionmentioning

confidence: 99%

Review of posttraumatic stress disorder and chronic pain: The path to integrated care

Gibson¹

2012

JRRD

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Abstract-With the large number of Veterans experiencing posttraumatic stress disorder (PTSD) and chronic pain, the purpose of this article is to review the prevalence of PTSD and chronic pain, the theoretical models that explain the maintenance of both conditions, and the challenges faced by providers and families who care for these patients. The Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress with special attention to chronic pain is presented. Limited scientific evidence supports specific care and treatment of PTSD and chronic pain, and this challenges providers to investigate and research potential treatment options. Integrated care models designed for working with these patients are reviewed, including a focus on the techniques and strategies to address not only PTSD and chronic pain, but other conditions, including substance dependence and depression. A specific focus on headaches, back pain, and neuropathic pain follows, including treatment recommendations such as pharmacological, psychotherapeutic, and complementary approaches, given the high rates of these pain complaints for Veterans in PTSD clinical programs. Integrated care is presented as a viable solution and approach that challenges clinicians and researchers to develop innovative, scientifically based therapeutics and treatments to enhance the recovery and quality of life for Veterans with PTSD and chronic pain.

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“…Consistent with data on patient preferences [36], VHA is working to build capacity for complementary and alternative medicine services [37], especially acupuncture [38,39]. Models of integrative care are emerging [31,40] and are beginning to be evaluated for their efficacy and, ultimately, their cost-effectiveness. Use of telehealth technologies such as videoconferencing and phone and web-based interventions are also supported through several medical care and research funding initiatives [33].…”

Section: Step 2: Specialty Carementioning

confidence: 99%

Implementation of the Veterans Health Administration National Pain Management Strategy

Kerns

Philip

Lee

et al. 2011

Behav. Med. Pract. Policy Res.

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Since its introduction in 1998, the VHA National Pain Management Strategy has introduced and implemented a series of plans for promoting systems improvements in pain care. We present the milestones of VHA efforts in pain management as reflected by the work of the Strategy. This includes the development of the Strategy and its current structure as well as a review of important initiatives such as "pain as the fifth vital sign" and the stepped care model of pain management. KEYWORDS Pain, Pain management, Primary care, VeteransAccording to the Institute of Medicine's recently published report on the state of pain care in the United States, "Relieving Pain in America: A Blueprint for Transforming Pain Prevention, Care, Education, and Research" [1], as many as one-third of Americans experience persistent pain at a cost of as much as $635 billion. The report noted that military Veterans are a particularly vulnerable group with data documenting a particularly high prevalence of pain and extraordinary rates of complexity associated with multiple medical and mental health comorbidities.Data document that as many as 50% of male Veterans treated at Veterans Health Administration (VHA) primary care clinics report the presence of pain [2], and the prevalence may even be as high as 75% among female Veterans returning from Afghanistan in Operation Enduring Freedom (OEF) or Iraq in Operation Iraqi Freedom (OIF) [3]. Painful musculoskeletal conditions are the most highly prevalent cluster of diagnosed medical conditions among OEF/OIF Veterans surpassing the rates of all diagnosed mental health conditions combined. Published observational data document that pain is one of the most frequent presenting complaints for OEF/OIF Veterans treated in the VHA particularly in patients with polytrauma [4][5][6]. In addition, reports suggest that the prevalence of pain complaints among Veterans is growing steadily with each passing year [7,8].Pain is associated with serious and diverse health problems. The presence of pain among Veterans receiving primary care in VHA facilities, relative to those not reporting pain, is associated with poorer self-rated health, greater utilization of healthcare resources, greater prevalence of health risk behaviors and factors such as tobacco use, excessive alcohol use, weight concerns, decreased social and physical activity, lower social support, and greater ratings of affective distress [9]. Among women Veterans, pain is associated with high rates of military and nonmilitary sexual harassment and trauma [10]. Finally, pain is also among the most costly disorders treated in VHA settings [11].This article describes a comprehensive VHA National Pain Management Strategy and its ambitious agenda for improving pain care for Veterans receiving care in its healthcare facilities. It includes a review of ongoing implementation efforts over the 1 PRIME Center/11ACSLG, VA Connecticut Healthcare System, West Haven, CT 06516, USA Implications Practice: A process including qualitative content evaluation, usabilit...

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The Development of an Integrated Treatment for Veterans with Comorbid Chronic Pain and Posttraumatic Stress Disorder

Abstract: Participants appeared to benefit from receiving the integrated treatment for pain and PTSD. A randomized clinical trial is currently being conducted to evaluate the efficacy of this treatment approach.

Cited by 154 publications

References 37 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

Review of posttraumatic stress disorder and chronic pain: The path to integrated care

Implementation of the Veterans Health Administration National Pain Management Strategy

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