title: Chronic pain acceptance incrementally predicts disability in polytrauma-exposed veterans at baseline and 1-year follow-up.
abstract: War veterans are at increased risk for chronic pain and co-occurring neurobehavioral problems, including posttraumatic stress disorder (PTSD), depression, alcohol-related problems, and mild traumatic brain injury (mTBI). Each condition is associated with disability, particularly when co-occurring. Pain acceptance is a strong predictor of lower levels of disability in chronic pain. This study examined whether acceptance of pain predicted current and future disability beyond the effects of these co-occurring conditions in war veterans. Eighty trauma-exposed veterans with chronic pain completed a PTSD diagnostic interview, clinician-administered mTBI screening, and self-report measures of disability, pain acceptance, depression, and alcohol use. Hierarchical regression models showed pain acceptance to be incrementally associated with disability after accounting for symptoms of PTSD, depression, alcohol-related problems, and mTBI (total adjusted R(2) = .57, p < .001, ΔR(2) = .03, p = .02). At 1-year follow-up, the total variance in disability accounted for by the model decreased (total adjusted R(2) = .29, p < .001), whereas the unique contribution of pain acceptance increased (ΔR(2) = .07, p = .008). Pain acceptance remained significantly associated with 1-year disability when pain severity was included in the model. Future research should evaluate treatments that address chronic pain acceptance and co-occurring conditions to promote functional recovery in the context of polytrauma in war veterans.
authors.affiliation: Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA; Texas A&M Health Science Center, College of Medicine, Temple, TX, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cook
authors.affiliation: Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA; Texas A&M Health Science Center, College of Medicine, Temple, TX, USA. Electronic address: Eric.Meyer2@va.gov.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Meyer
authors.affiliation: Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA.
authors.forename: Lianna D
authors.initials: LD
authors.lastname: Evans
authors.affiliation: Department of Psychology, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Vowles
authors.affiliation: Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Klocek
authors.affiliation: Durham VA Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Kimbrel
authors.affiliation: Texas A&M Health Science Center, College of Medicine, Temple, TX, USA; Warriors Research Institute, Baylor Scott & White Healthcare System, Waco, TX, USA.
authors.forename: Suzy Bird
authors.initials: SB
authors.lastname: Gulliver
authors.affiliation: Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA; Texas A&M Health Science Center, College of Medicine, Temple, TX, USA.
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Morissette
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000503:physiopathology / Q000517:prevention & control; D059350:Chronic Pain / Q000503:physiopathology / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000503:physiopathology; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000503:physiopathology; D014728:Veterans; D055815:Young Adult
keywords: Acceptance; Chronic pain; Disability; Functioning; Posttraumatic stress disorder; Veterans