scholarly journals Military veterans with and without post-traumatic stress disorder: results from a chronic pain management programme

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jannie Van Der Merwe ◽  
Suzanne Brook ◽  
Claire Fear ◽  
Maxwell J. Benjamin ◽  
Gerald Libby ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Military Veterans ◽  
Integrated Treatment ◽  
Management Programme ◽  
Post Traumatic Stress ◽  
Post Traumatic

AbstractBackground and aimsThere is very little published evaluation of the treatment of military veterans with chronic pain, with or without post-traumatic stress disorder. Few clinical services offer integrated treatment for veterans with chronic pain and PTSD. Such veterans experience difficulty in accessing treatment for either condition: services may consider each condition as a contraindication to treatment of the other. Veterans are therefore often passed from one specialist service to another without adequate treatment. The veteran pain management programme (PMP) in the UK was established to meet the needs of veterans suffering from chronic pain with or without PTSD; this is the first evaluation.MethodsThe PMP was advertised online via veteran charities. Veterans self-referred with accompanying information from General Practitioners. Veterans were then invited for an inter-disciplinary assessment and if appropriate invited onto the next PMP. Exclusion criteria included; current severe PTSD, severe depression with active suicidal ideation, moderate to severe personality disorder, or who were unable to self-care in the accommodation available. Treatment was by a team of experienced pain management clinicians: clinical psychologist, physiotherapist, nurse, medical consultant and psychiatrist. The PMP was delivered over 10 days: five residential days then five single days over the subsequent 6 months. The PMP combines cognitive behavioural treatment, which has the strongest evidence base, with more recent developments from mindfulness-based CBT for pain and compassion-focused therapy. Standard pain management strategies were adapted to meet the specific needs of the population, recognising the tendency to use demanding activity to manage post-traumatic stress symptoms. Domains of outcome were pain, mood, function, confidence and changes in medication use.ResultsOne hundred and sixty four military veterans started treatment in 19 programmes, and 158 completed. Results from those with high and low PTSD were compared; overall improvements in all domains were statistically significant: mood, self-efficacy and confidence, and those with PTSD showed a reduction (4.3/24 points on the IES-6). At the end of the programme the data showed that 17% reduced opioid medication and 25% stopped all opioid use.ConclusionsVeterans made clinically and statistically significant improvements, including those with co-existing PTSD, who also reduced their symptom level. This serves to demonstrate the feasibility of treating veterans with both chronic pain and PTSD using a PMP model of care.ImplicationsMilitary veterans experiencing both chronic pain and PTSD can be treated in a PMP adapted for their specific needs by an experienced clinical team.

Post-traumatic stress disorder and risky opioid use among persons living with HIV and chronic pain

AIDS Care ◽  
2021 ◽  
pp. 1-8
Author(s):  
Elenore Bhatraju ◽  
Jane M. Liebschutz ◽  
Sara Lodi ◽  
Leah S. Forman ◽  
Marlene C. Lira ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Opioid Use ◽  
Persons Living With Hiv ◽  
Post Traumatic ◽  
Living With Hiv

Post-traumatic stress disorder among patients with chronic pain and chronic fatigue

2004 ◽  
Vol 34 (2) ◽  
pp. 363-368 ◽  
Author(s):  
P. ROY-BYRNE ◽  
W. R. SMITH ◽  
J. GOLDBERG ◽  
N. AFARI ◽  
D. BUCHWALD
Keyword(s):  
Chronic Pain ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Clinical Care ◽  
Chronic Fatigue ◽  
Psychiatric Evaluation ◽  
Post Traumatic Stress ◽  
Tender Points ◽  
Post Traumatic

Background. Fibromyalgia (FM), a chronic pain condition of unknown aetiology often develops following a traumatic event. FM has been associated with post-traumatic stress disorder (PTSD) and major depression disorder (MDD).Method. Patients seen in a referral clinic (N=571) were evaluated for FM and chronic fatigue syndrome (CFS) criteria. Patients completed questionnaires, and underwent a physical examination and a structured psychiatric evaluation. Critical components of the diagnostic criteria of FM (tender points and diffuse pain) and CFS (persistent debilitating fatigue and four of eight associated symptoms) were examined for their relationship with PTSD.Results. The prevalence of lifetime PTSD was 20% and lifetime MDD was 42%. Patients who had both tender points and diffuse pain had a higher prevalence of PTSD (OR=3·4, 95% CI 2·0–5·8) compared with those who had neither of these FM criteria. Stratification by MDD and adjustment for sociodemographic factors and chronic fatigue revealed that the association of PTSD with FM criteria was confined to those with MDD. Patients with MDD who met both components of the FM criteria had a three-fold increase in the prevalence of PTSD (95% CI 1·5–7·1); conversely, FM patients without MDD showed no increase in PTSD (OR=1·3, 95% CI 0·5–3·2). The components of the CFS criteria were not significantly associated with PTSD.Conclusion. Optimal clinical care for patients with FM should include an assessment of trauma in general, and PTSD in particular. This study highlights the importance of considering co-morbid MDD as an effect modifier in analyses that explore PTSD in patients with FM.

Impact of comorbid post traumatic stress disorder on multiple sclerosis in military veterans: A population-based cohort study

2021 ◽  
pp. 135245852110583
Author(s):  
Mark Leekoff ◽  
William Culpepper ◽  
Shan Jin ◽  
Terry Lee-Wilk ◽  
Mitchell Wallin
Keyword(s):  
Multiple Sclerosis ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Military Veterans ◽  
Brain Mri ◽  
Population Based ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
The Impact

Background: Very little is known regarding the impact of post traumatic stress disorder (PTSD) on the course of multiple sclerosis (MS). Objectives: To explore the impact of pre-existing PTSD on MS relapses, magnetic resonance imaging (MRI) activity, and disability in a large population-based cohort. Methods: Military Veterans with MS and PTSD prior to symptom onset (MSPTSD, n = 96) were identified using the Department of Veterans Affairs MS databases. MSPTSD cases were matched to MS controls without PTSD ( n = 95). Number of relapses, number of new T2 lesions and new gadolinium lesions on brain MRI, and neurological disability were abstracted between 2015 and 2019. Results: The mean annualized relapse rate was greater in the MSPTSD group versus controls (0.23 vs 0.06, respectively; p < 0.05), as was the annualized mean number of new T2 and gadolinium-enhancing lesions on brain MRI (0.52 vs 0.16 and 0.29 vs 0.08, respectively; p < 0.05). Disability accrual (time to Disability Status Scale 6.0) was more rapid (23.7 vs 29.5 years, p < 0.05) in relapsing MS patients with PTSD. Conclusion: Patients with MSPTSD have higher disease activity and reach disability endpoints more rapidly than controls. This is the first study to show PTSD as a potentially modifiable risk factor for MS relapses, MRI activity, and disability.

Post-traumatic Stress Disorder and Chronic Pain in the Military

2020 ◽  
pp. 189-202
Author(s):  
Jordana L. Sommer ◽  
Rachel Roy ◽  
Pamela L. Holens ◽  
Renée El-Gabalawy
Keyword(s):  
Chronic Pain ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
The United States ◽  
Post Traumatic Stress ◽  
Psychosocial Effects ◽  
The United Kingdom ◽  
Military Populations ◽  
Post Traumatic

This chapter summarizes the current literature on post-traumatic stress disorder (PTSD) and chronic pain among military personnel in Canada, the United States, and the United Kingdom, including an overview of clinical features, prevalence, correlates, comorbidity, assessment, and intervention. PTSD and chronic pain are both prevalent among military populations and commonly co-occur; however, prevalence estimates tend to vary in the literature, according to type of assessment, timing of assessment, and subsample of interest. Both PTSD and chronic pain are independently associated with various adverse correlates such as psychiatric and physical health comorbidity, and research suggests there are poorer health and adverse psychosocial effects when these conditions co-occur. These findings highlight the importance of adequate prevention, screening, and interventions among this population.

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