title: Exploring the role of insomnia in the relation between PTSD and pain in veterans with polytrauma injuries.
abstract: BACKGROUND
  Soldiers returning from Operation Enduring Freedom/Operation Iraqi Freedom experience polytrauma injuries including traumatic brain injury. Traumatic brain injury is often complicated by symptoms of insomnia, posttraumatic stress disorder (PTSD), and pain that can impact treatment and rehabilitation.
  
  
  METHODS
  The medical records of 137 veterans seen at a Veterans Affairs Medical Center Polytrauma clinic who sustained traumatic brain injury in combat were reviewed for this study. Demographic variables include age, sex, ethnicity, military branch, and service connection. Outcome measures include PTSD, pain, and insomnia.
  
  
  RESULTS
  Analyses revealed a high prevalence of PTSD, insomnia, and pain co-occurring in 51.8% of veterans. Increased PTSD symptomatology was significantly correlated with reports of more pain severity (r = 0.53), pain interference (r = 0.61), and insomnia (r = 0.67). Further analyses, controlling for service connection, indicated that insomnia partially mediated the relation between PTSD and both pain severity and interference.
  
  
  CONCLUSIONS
  These results highlight the overlap and complexity of presenting complaints in veterans and help identify the role of sleep disturbances in complicating diagnosis and treatment of veterans. As sleep problems reduce pain tolerance and exacerbate other symptoms, such as cognitive deficits and irritability, failure to address sleep disturbances may compromise rehabilitation efforts, suggesting the importance of a multidisciplinary team approach to assessing and treating these veterans.
authors.affiliation: Department of Psychology, The University of Memphis (Ms Lang and Drs Veazey-Morris and Andrasik), and Memphis VA Medical Center, Memphis, Tennessee (Dr Veazey-Morris).
authors.forename: Katie P
authors.initials: KP
authors.lastname: Lang
authors.forename: Katherine
authors.initials: K
authors.lastname: Veazey-Morris
authors.forename: Frank
authors.initials: F
authors.lastname: Andrasik
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation; D010147:Pain Measurement / Q000706:statistics & numerical data; D011594:Psychometrics; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation; D013223:Statistics as Topic; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation; D014481:United States; D014728:Veterans / Q000523:psychology*