title: Treatment of comorbid pain and PTSD in returning veterans: a collaborative approach utilizing behavioral activation.
abstract: OBJECTIVE
  We explore preliminary clinical effectiveness and feasibility of an intervention utilizing collaborative care components and behavioral activation (BA) to treat comorbid chronic pain and posttraumatic stress disorder (PTSD).
  
  
  METHODS
  Descriptive, including pre- and posttreatment assessment results.
  
  
  METHODS
  Portland Veterans Affairs Medical Center.
  
  
  METHODS
  Fifty-eight Iraq and Afghanistan veterans with chronic pain and PTSD symptoms.
  
  
  METHODS
  Veterans participated in a biopsychosocial evaluation and up to eight BA sessions using a collaborative approach involving primary care, mental health, and other clinicians. A physiatrist assisted the psychologist in providing recommendations to primary care providers.
  
  
  METHODS
  Participants were administered pre- and posttreatment measures of PTSD, pain severity, pain interference, mental health, quality of life, satisfaction, and global ratings of change with the purpose of assessing progress and improving quality.
  
  
  RESULTS
  Of the 58 participants, 30 completed treatment. Common recommendations included physical therapy and exercise programs, pain medication or pain medication adjustments, and additional diagnostic workups, such as imaging. Participants who completed the program showed significant improvements on measures of PTSD, pain severity, and pain interference. Improvements were also evident on measures of mental health and quality of life. Overall, participants were satisfied with the program, and on average reported feeling "somewhat better."
  
  
  CONCLUSIONS
  These findings suggest that a collaborative approach that includes BA is feasible and a potentially effective treatment for comorbid chronic pain and PTSD.
authors.affiliation: Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, Oregon 97239, USA.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Plagge
authors.forename: Mary W
authors.initials: MW
authors.lastname: Lu
authors.forename: Travis I
authors.initials: TI
authors.lastname: Lovejoy
authors.forename: Andrea I
authors.initials: AI
authors.lastname: Karl
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
mesh_terms: D000328:Adult; D001519:Behavior / Q000187:drug effects*; D001521:Behavior Therapy; D001930:Brain Injuries / Q000150:complications; D059350:Chronic Pain / Q000150:complications; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D010146:Pain / Q000150:complications* / Q000523:psychology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011788:Quality of Life; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*
keywords: Behavioral Activation; Collaborative Care; Pain; Posttraumatic Stress Disorder; Veterans