title: Review of posttraumatic stress disorder and chronic pain: the path to integrated care.
abstract: With the large number of Veterans experiencing posttraumatic stress disorder (PTSD) and chronic pain, the purpose of this article is to review the prevalence of PTSD and chronic pain, the theoretical models that explain the maintenance of both conditions, and the challenges faced by providers and families who care for these patients. The Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD  Clinical Practice Guideline for Management of Post-Traumatic  Stress with special attention to chronic pain is presented. Limited scientific evidence supports specific care and treatment of PTSD and chronic pain, and this challenges providers to investigate and research potential treatment options. Integrated care models designed for working with these patients are reviewed, including a focus on the techniques and strategies to address not only PTSD and chronic pain, but other conditions, including substance dependence and depression. A specific focus on headaches, back pain, and neuropathic pain follows, including treatment recommendations such as pharmacological, psychotherapeutic, and complementary approaches, given the high rates of these pain complaints for Veterans in PTSD clinical programs. Integrated care is presented as a viable solution and approach that challenges clinicians and researchers to develop innovative, scientifically based therapeutics and treatments to enhance the recovery and quality of life for Veterans with PTSD and chronic pain.
authors.affiliation: Mental Health and Behavioral Sciences Service, James A. Haley Veterans’ Hospital, Tampa, FL 33612, USA. carri-ann.gibson1@va.gov
authors.forename: Carri-Ann
authors.initials: CA
authors.lastname: Gibson
mesh_terms: D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D006077:Government Agencies; D006801:Humans; D010146:Pain / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans