title: Association of Chronic Pain and Community Integration of Returning Veterans With and Without Traumatic Brain Injury.
abstract: OBJECTIVE
  To evaluate the association between community integration and pain in veterans with and without mild blast-related traumatic brain injury (TBI).
  
  
  METHODS
  A cross-sectional study of 198 Operation Enduring Freedom/Operation Iraqi Freedom veterans, 135 with mild TBI and 63 without TBI exposure.
  
  
  METHODS
  Community Integration Questionnaire (CIQ), Community Reintegration of Injured Service Members Instrument, Brief Pain Inventory.
  
  
  RESULTS
  Pain interference was significantly associated with CIQ social integration (P = .037), and pain severity was significantly associated with CIQ home integration (P = .038) and CIQ social integration (P = .044). Pain interference and pain severity had a significant interaction as related to the CIQ total score (P = .046), CIQ job score (P = .034), and CIQ productivity score (P = .034). Pain interference (P = .042) and pain severity (P = .015) were associated with community participation, but not perceived limitations (P > .05) or satisfaction (P > .05) as measures by the Community Reintegration of Injured Service Members Instrument. There was a significant interaction between TBI status and pain severity (P = .021) with community participation.
  
  
  CONCLUSIONS
  Chronic pain has a negative association with the community integration of returning veterans. Although TBI status was associated with overall community integration ratings, depression had a stronger association with impairments. These findings suggest, above and beyond the treatment of depression, the importance of effectively managing TBI-related pain to foster improved social functioning and to promote the psychological and social well-being of returning veterans.
authors.affiliation: Neurorehabilitation: Neurons to Networks Traumatic Brain Injury Center of Excellence, Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas (Ms Wu and Dr Graham); Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas (Dr Graham); and Department of Veterans Affairs, South Central Mental Illness, Research, Education and Clinical Center (MIRECC), Houston, Texas (Dr Graham).
authors.forename: Emily
authors.initials: E
authors.lastname: Wu
authors.forename: David P
authors.initials: DP
authors.lastname: Graham
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000453:epidemiology*; D016022:Case-Control Studies; D059350:Chronic Pain / Q000523:psychology*; D062309:Community Integration; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D012720:Severity of Illness Index; D012917:Social Adjustment; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014728:Veterans