PTSD as a Mediator in the Relationship Between Post-Concussive Symptoms and Pain Among OEF/OIF/OND Veterans

• Type of Material: Article
• Authors: Kimberly M Avallone, VA Ann Arbor Healthcare System; Erin R Smith, VA Ann Arbor Healthcare System; Sean Ma, University of Michigan; MAJ. Sean Gargan, University of Michigan; Katherine E Porter, VA Ann Arbor Healthcare System; Caitlin C Authier, University of Michigan; Brian Martis, VA Ann Arbor Healthcare System; Israel Liberzon, VA Ann Arbor Healthcare System; Sheila Rauch, Emory University
• Language: English
• Date: 2019-01-01
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option B
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Association of Military Surgeons of the United States. All rights reserved.
• License: Creative Commons Creative Commons CC0 1.0 Universal
• Final Published Version (URL): http://dx.doi.org/10.1093/milmed/usy225
• Title of Journal or Parent Work: Military Medicine
• ISSN: 0026-4075
• Volume: 184
• Issue: 1-2
• Start Page: E118
• End Page: E123
• Grant/Funding Information: The VA Ann Arbor Healthcare System, Ralph H. Johnson VA Medical Center, and VA San Diego Healthcare System; This work was supported by the United States Army Medical Research and Materiel Command (MRMC; Grant #W81XWH-11-1-0073); the National Center for Advancing Translational Sciences of the National Institutes of Health (Grant #UL1TR000433).
• Keywords: Medicine, General & Internal; PERSISTENT POSTCONCUSSIVE SYMPTOMS; DIAGNOSES; IMPACT; AFGHANISTAN; Life Sciences & Biomedicine; POSTTRAUMATIC-STRESS-DISORDER; General & Internal Medicine; TBI; DEPLOYMENT; IRAQ; TRAUMATIC BRAIN-INJURY; Science & Technology; SEEKING TREATMENT
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Introduction: Traumatic brain injury (TBI), pain, and post-traumatic stress disorder (PTSD) commonly co-occur in Veteran populations, particularly among Veterans returning from the recent conflicts in Iraq and Afghanistan. Extant research indicates that both TBI and PTSD can negatively impact pain broadly; however, less is known about how these variables impact one another. The current study examines the impact of self-reported post-concussive symptoms on both pain severity and pain interference among Veterans with PTSD who screened positive for a possible TBI, and subsequently, evaluates the potential mediating role of PTSD in these relationships. Materials and Methods: Participants were 126 combat Veterans that served in Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn who were being evaluated for participation in a multisite treatment outcomes study. As part of an initial evaluation for inclusion in the study, participants completed several self-report measures and interviews, including the Brief Traumatic Brain Injury Screen, Neurobehavioral Symptom Inventory, Brief Pain Inventory, and the Clinician Administered PTSD Scale, which were utilized in these analyses. Results: For pain severity, greater post-concussive symptoms significantly predicted increased pain severity with a significant indirect effect of postconcussive symptoms on pain severity through PTSD (indirect effect = 0.03; 95% confidence interval = 0.0094-0.0526). Similar results were found for pain interference (indirect effect = 0.03; 95% confidence interval = 0.0075-0.0471). Conclusions: These findings replicate and extend previous findings regarding the relationship between TBI, pain, and PTSD. Self-reported post-concussive symptoms negatively impact both pain severity and pain interference among Veterans with probable TBI, and PTSD serves as a mediator in these relationships. Clinically, these results highlight the importance of fully assessing for PTSD symptoms in Veterans with a history of TBI presenting with pain. Further, it is possible that providing effective PTSD treatment to reduce PTSD severity may provide some benefit in reducing post-concussive and pain symptoms.