Pain and PTSD Common Comorbidities among OEF/OIF Veterans with Spinal Cord Injury Undergoing Inpatient Rehabilitation
Elevated risk for PTSD is to be expected after traumatic spinal cord injury (SCI) because such injuries frequently expose a person to extreme physical injury and threat of death. In addition, research has linked PTSD to the experience of pain, and high rates of comorbid pain and PTSD have been documented in a number of other studies focusing on OEF/OIF Veterans. This retrospective study examined how PTSD symptoms were associated with acute pain severity ratings and the longitudinal course of pain during inpatient rehabilitation for OEF/OIF Veterans with SCI. Using VA data, investigators identified 87 OEF/OIF Veterans who received inpatient rehabilitation for SCI at one of 24 VA SCI Centers between 5/03 and 10/09. Measures included PTSD symptoms (using primary care PTSD screen), pain (using scale of 0-10), and patient demographics. Baseline pain and PTSD symptom measures were used to categorize Veterans into four groups: Pain & PTSD (n=26), Pain Alone (n=22), PTSD Alone (n=12), and Neither Condition (n=27). Differences between baseline pain and overall pain score were assessed to describe changes in pain scores over time.
- Pain and PTSD were more likely to manifest as comorbidities than as isolated conditions during inpatient rehabilitation. Comorbid pain and PTSD symptoms were more common than either condition alone, and nearly as common as not having either condition.
- Veterans with pain at the beginning of rehabilitation (Pain & PTSD and Pain Alone groups) showed declines in pain ratings over the course of rehabilitation. In contrast, Veterans in the PTSD Alone group showed increasing pain over the course of rehabilitation.
- Factors not associated with pain and PTSD status were: demographic and SCI characteristics, number of comorbid traumatic injuries, and the prevalence of individual comorbid injuries.
- This study focused on Veterans with SCI and acute pain, therefore results may not generalize to persons with chronic pain conditions.
- The study cohort was small and limited to OEF/OIF Veterans.
- Findings may have differed if additional pain assessments or PTSD diagnoses had been available.
The authors suggest that assessment routines and care plans should be prepared with comorbidities as a foremost concern. They also suggest that patients with SCI be screened for pain and a range of psychological concerns, including PTSD, at multiple time-points during inpatient rehabilitation, and that treatment plans be tailored to address comorbidities.
This study was supported by HSR&D (IIR 07-188). Drs. Smith, Evans, Stroupe, Weaver, and Burns are part of HSR&D's Center for Management of Complex Chronic Care; Dr. Weaver also is Director of VA/HSR&D's Spinal Cord Injury Quality Enhancement Research Initiative (SCI-QUERI).
Ullrich P, Smith B, Poggensee L, Evans C, Stroupe K, Weaver F, and Burns S. Pain and PTSD Symptoms During Inpatient Rehabilitation among OEF/OIF Veterans with Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation August 1, 2012;e-pub ahead of print.