Comorbid Chronic Pain and Posttraumatic Stress Disorder Among Veterans: Approaches to Care.

Pratt AA, Van Tiem J, Lund BC, Johnson NL, Steffensmeier KRS, Ball DD, Thomas EBK, Mengeling MA, Norman SB, Driscoll MA, Garvin L, Hart KJ, Hadlandsmyth K. Comorbid Chronic Pain and Posttraumatic Stress Disorder Among Veterans: Approaches to Care. Military medicine. 2025 Apr 11 DOI: 10.1093/milmed/usaf118.

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Abstract:

INTRODUCTION: The aim is to elucidate approaches to care for comorbid chronic pain and PTSD (CP + PTSD) in the Veterans Administration (VA). These conditions are co-magnifying and highly comorbid but traditionally treated in separate clinical settings. MATERIALS AND METHODS: This multimethod analysis examined care for CP + PTSD via administrative data analyses and qualitative interviews of VA-served veterans. RESULTS: All participants with diagnoses of CP + PTSD in 2021 were identified using VA administrative data (N = 456,544). Visits during the following year (2022) coded for chronic pain, PTSD, or both were analyzed. Qualitative interview participants (N = 22) were recruited, screened, consented, and enrolled in 2023. Administrative findings demonstrated that clinical settings differed where CP and PTSD were treated. For PTSD, 90.7% of visits occurred in the mental health service line, whereas for CP, visits occurred across a range of settings outside mental health (e.g., primary care, rehabilitative services, and surgical services). A small percentage of visits (4.8%) were coded for both CP + PTSD, indicating possible combined care. In qualitative interviews, participants acknowledged that CP and PTSD symptoms may impact one another but noted that the health care they received for these 2 conditions was typically siloed. Participants also identified barriers that would need to be addressed before a fully integrated coordinated care model could be implemented. CONCLUSIONS: Veterans reported interest in coordinated treatment for CP + PTSD; however, the provision of CP + PTSD care provided across different service lines may pose challenges to optimizing care coordination.