title: Pain experience of Iraq and Afghanistan Veterans with comorbid chronic pain and posttraumatic stress.
abstract: Chronic pain and posttraumatic stress disorder (PTSD) co-occur at high rates, and Veterans from recent wars in Iraq and Afghanistan may be particularly vulnerable to both conditions. The objective of this study was to identify key aspects of chronic pain, cognitions, and psychological distress associated with comorbid PTSD among this sample of Veterans. Baseline data were analyzed from a randomized controlled trial testing a stepped-care intervention for chronic musculoskeletal pain. Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans with chronic pain only (n = 173) were compared with those with chronic pain and clinically significant posttraumatic stress symptoms (n = 68). Group differences on pain characteristics, pain cognitions, and psychological distress were evaluated. Results demonstrated that OIF/OEF Veterans with comorbid chronic musculoskeletal pain and PTSD experienced higher pain severity, greater pain-related disability and increased pain interference, more maladaptive pain cognitions (e.g., catastrophizing, self-efficacy, pain centrality), and higher affective distress than those with chronic pain alone. Veterans of recent military conflicts in Iraq and Afghanistan may be particularly vulnerable to the compounded adverse effects of chronic pain and PTSD. These results highlight a more intense and disabling pain and psychological experience for those with chronic pain and PTSD than for those without PTSD.
authors.affiliation: Roudebush VA Medical Center, 1481 W 10th St (11H), Indianapolis, IN 46202. soutcalt@iupui.edu.
authors.forename: Samantha D
authors.initials: SD
authors.lastname: Outcalt
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Ang
authors.forename: Jingwei
authors.initials: J
authors.lastname: Wu
authors.forename: Christy
authors.initials: C
authors.lastname: Sargent
authors.forename: Zhangsheng
authors.initials: Z
authors.lastname: Yu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bair
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000209:etiology; D055826:Afghan Campaign 2001-; D000368:Aged; D001007:Anxiety / Q000209:etiology; D059350:Chronic Pain / Q000453:epidemiology* / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000209:etiology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000453:epidemiology* / Q000523:psychology*; D010147:Pain Measurement; D058748:Pain Perception; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Veteran health; Veterans; chronic pain; cognitions; comorbidity; mental 
  health; musculoskeletal pain; pain severity; posttraumatic 
  stress; trauma