Abstract
Objectives
Post-traumatic stress disorder (PTSD) is thought to complicate pain management outcomes,
which is consistent with the impact of other psychosocial factors in the biopsychosocial
model of pain. This study aimed to identify patient sociodemographic and clinical
characteristics associated with PTSD prevalence among veterans of Operations Enduring
Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) who received Veterans Affairs (VA) chiropractic
care.
Methods
A cross-sectional analysis of electronic health record data from a national cohort
study of OEF/OIF/OND veterans with at least 1 visit to a VA chiropractic clinic from
2001 to 2014 was performed. The primary outcome measure was a prior PTSD diagnosis.
Variables including sex, race, age, body mass index, pain intensity, alcohol and substance
use disorders, and smoking status were examined in association with PTSD diagnosis
using logistic regression.
Results
We identified 14,025 OEF/OIF/OND veterans with at least 1 VA chiropractic visit, with
a mean age of 38 years and 54.2% having a diagnosis of PTSD. Male sex (adjusted odds
ratio [OR] = 1.23, 95% CI = 1.11-1.37), younger age (OR = 0.99, CI = 0.98-0.99), moderate-to-severe
pain intensity (numerical rating scale ≥ 4) (OR = 1.72, CI = 1.59-1.87), body mass
index ≥ 30 (OR = 1.34, CI = 1.24-1.45), current smoking (OR = 1.32, CI = 1.20-1.44),
and having an alcohol or substance use disorder (OR = 4.51, CI = 4.01-5.08) were significantly
associated with a higher likelihood of PTSD diagnosis.
Conclusion
Post-traumatic stress disorder is a common comorbidity among OEF/OIF/OND veterans
receiving VA chiropractic care and is significantly associated with several patient
characteristics. Recognition of these factors is important for the appropriate diagnosis
and management of veterans with PTSD seeking chiropractic treatment for pain conditions.
Key Indexing Terms
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References
- Prevalence, comorbidity, and prognosis of mental health among US veterans.Am J Public Health. 2015; 105: 2564-2569
- Associations of stress exposures and social support with long-term mental health outcomes among U.S. Iraq War veterans.Behav Ther. 2018; 49: 653-667
Veterans Committee on the Initial Assessment of Readjustment Needs of Military Personnel, Board on the Health of Selected Populations, Institute of Medicine. Returning home from Iraq and Afghanistan: preliminary assessment of readjustment needs of veterans, service members, and their families. Available at:https://www.nap.edu/catalog/12812/returning-home-from-iraq-and-afghanistan-preliminary-assessment-of-readjustment. Accessed March 2019.
Epidemiology Program, Post-Deployment Health Group, Office of Patient Care Services, Veterans Health Administration, Department of Veterans Affairs. Analysis of VA health care utilization among Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn Veterans, from 1st Qtr FY 2002 through 3rd Qtr FY 2015. Available at:https://www.publichealth.va.gov/docs/epidemiology/healthcare-utilization-report-fy2015-qtr3.pdf. Accessed March 2019.
- Characteristics associated with utilization of VA and non-VA care among Iraq and Afghanistan veterans with post-traumatic stress disorder.Mil Med. 2017; 182: e1892-e1903
- Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: possible explanations.J Trauma Stress. 2010; 23: 59-68
- Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008.Am J Public Health. 2009; 99: 1651-1658
- Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan.Curr Psychiatry Rep. 2015; 17: 37
- Diagnostic and Statistical Manual of Mental Disorders.5th ed. American Psychiatric Publishing, Arlington, VA2013
- Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF/OEF veterans: polytrauma clinical triad.J Rehabil Res Dev. 2009; 46: 697-702
- Conceptualizing and treating comorbid chronic pain and PTSD.Pain Res Treat. 2013; 2013174728
- Chronic pain types differ in their reported prevalence of post -traumatic stress disorder (PTSD) and there is consistent evidence that chronic pain is associated with PTSD: an evidence-based structured systematic review.Pain Med. 2017; 18: 711-735
- Persistent pain and comorbidity among Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans.Pain Med. 2014; 15: 782-790
- The relationship between PTSD and chronic pain: mediating role of coping strategies and depression.Pain. 2013; 154: 609-616
- Opioid dosing trends over eight years among US veterans with musculoskeletal disorders after returning from service in support of recent conflicts.Ann Epidemiol. 2017; 27 (e3): 563-569
- A national cohort study of the association between the polytrauma clinical triad and suicide-related behavior among US veterans who served in Iraq and Afghanistan.Am J Public Health. 2015; 105: 380-387
- Trends in the use and characteristics of chiropractic services in the Department of Veterans Affairs.J Manipulative Physiol Ther. 2016; 39: 381-386
- Preliminary analysis of posttraumatic stress disorder screening within specialty clinic setting for OIF/OEF veterans seeking care for neck or back pain.J Rehabil Res Dev. 2011; 48: 493-502
- Opioid use among veterans of recent wars receiving Veterans Affairs chiropractic care.Pain Med. 2018; 19: S54-S60
- A cross-sectional analysis of clinical outcomes following chiropractic care in veterans with and without post-traumatic stress disorder.Mil Med. 2009; 174: 578-583
Office of Mental Health and Suicide Prevention, Veterans Health Administration, Department of Veterans Affairs. National strategy for preventing veteran suicide. Available at:https://www.mentalhealth.va.gov/suicide_prevention/docs/Office-of-Mental-Health-and-Suicide-Prevention-National-Strategy-for-Preventing-Veterans-Suicide.pdf. Accessed March 2019.
- STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.J Clin Epidemiol. 2008; 61: 344-349
Elixhauser A, Steinder C, Palmer L. Clinical classifications software (CCS) for ICD-9-CM. Available at:https://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed December 2018.
- PTSD diagnoses among Iraq and Afghanistan veterans: comparison of administrative data to chart review.J Trauma Stress. 2014; 27: 626-629
- Agreement between electronic medical record-based and self-administered pain numeric rating scale: clinical and research implications.Med Care. 2013; 51: 245-250
Centers for Disease Control and Prevention. Healthy weight: about adult BMI. Centers for Available at:https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. Accessed December 2018.
- Validating smoking data from the Veteran's Affairs Health Factors dataset, an electronic data source.Nicotine Tob Res. 2011; 13: 1233-1239
- A simulation study of the number of events per variable in logistic regression analysis.J Clin Epidemiol. 1996; 49: 1373-1379
National Center for Veterans Analysis and Statistics, Department of Veterans Affairs. Key statistics by veteran status and period of service. Available at: https://www.va.gov/vetdata/docs/SpecialReports/KeyStats.pdf. Accessed March 2019.
- The obesity epidemic in the Veterans Health Administration: prevalence among key population of women and men veterans.J Gen Intern Med. 2017; 32: 11-17
- A review of posttraumatic stress disorder and obesity: exploring the link.Prim Care Companion CNS Disord. 2016; 18
- Stress- and PTSD-associated obesity and metabolic dysfunction: a growing problem requiring further research and novel treatments.Metabolism. 2014; 63: 1463-1468
- Gender differences in rates of depression, PTSD, pain, obesity, and military sexual trauma among Connecticut war veterans of Iraq and Afghanistan.J Womens Health (Larchmt). 2010; 19: 267-271
- Post-traumatic stress disorder by gender and veteran status.Am J Prev Med. 2018; 54: e1-e9
- Influence of PTSD symptom clusters on smoking status among help-seeking Iraq and Afghanistan veterans.Nicotine Tob Res. 2009; 11: 1189-1195
- Gender differences in substance abuse, PTSD and intentional self-harm among Veterans Health Administration patients.Drug Alcohol Depend. 2017; 171: 66-69
- Pain experience among Iraq and Afghanistan veterans with comorbid chronic pain and posttraumatic stress.J Rehabil Res Dev. 2014; 51: 559-570
- Altered pain processing in veterans with posttraumatic stress disorder.Arch Gen Psychiatry. 2007; 64: 76-85
- Evidence for acute central sensitization to prolonged experimental pain in posttraumatic stress disorder.Pain Med. 2014; 15: 762-771
- Chronic pain and posttraumatic stress disorder: mutual maintenance?.Clin Psychol Rev. 2001; 21: 857-877
- Altered pain perception and fear-learning deficits in subjects with posttraumatic stress disorder.J Pain. 2016; 17: 1325-1333
- PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models.Can J Psychiatry. 2002; 47: 930-937
- Chronic pain and mental health disorders: shared neural mechanisms, epidemiology, and treatment.Mayo Clin Proc. 2016; 91: 955-970
- A research agenda for advancing non-pharmacological management of chronic musculoskeletal pain: findings from a VHA state-of-the-art conference.J Gen Intern Med. 2018; 33: 11-15
Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Trauma-informed care in behavioral health services. Treatment improvement protocol (TIP) series 57. Available at: https://www.integration.samhsa.gov/clinical-practice/SAMSA_TIP_Trauma.pdf. Accessed April 2019.
- The development of an integrated treatment for veterans with comorbid chronic pain and posttraumatic stress disorder.Pain Med. 2009; 10: 1300-1311
- Treatment of comorbid pain and PTSD in returning veterans: a collaborative approach utilizing behavioral activation.Pain Med. 2013; 14: 1164-1172
- Review of posttraumatic stress disorder and chronic pain: the path to integrated care.J Rehabil Res Dev. 2012; 49: 753-776
Article info
Publication history
Published online: June 11, 2020
Accepted:
October 22,
2019
Received in revised form:
August 16,
2019
Received:
May 10,
2019
Identification
Copyright
© 2020 by National University of Health Sciences.
