title: Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans.
abstract: Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are common among US veterans of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). We postulated that these injuries may modulate pain processing in these individuals and affect their subjective pain levels.
  
  
  
  Cross-sectional.
  
  
  
  310 deployed service members of OEF/OIF/OND without a lifetime history of moderate or severe TBI were included in this study.
  
  
  
  All participants completed a comprehensive evaluation for Blast Exposure, mTBI, PTSD, and Pain Levels. The Boston Assessment of TBI-Lifetime Version (BAT-L) was used to assess blast exposure and potential brain injury during military service. The Clinician-Administered PTSD Scale (CAPS) characterized presence and severity of PTSD. The Visual Analog Scale (VAS) was used to assess pain intensity over the previous month before the interview, with higher scores indicative of worse pain. Statistical analysis was performed by ANOVA and results were adjusted for co-morbidities, clinical characteristics and demographic data.
  
  
  
  In comparison to control participants (veterans without mTBI or current PTSD), veterans with both current PTSD and mTBI reported the highest pain intensity levels, followed by veterans with PTSD only (P < 0.0001 and P = 0.0005, respectively). Pain levels in veterans with mTBI only were comparable to control participants.
  
  
  
  Comorbid PTSD and mTBI is associated with increased self-reported pain intensity. mTBI alone was not associated with increased pain.
authors.affiliation: *Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts mpstojanovic@gmail.com.
authors.forename: Milan P
authors.initials: MP
authors.lastname: Stojanovic
authors.affiliation: Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.|Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fonda
authors.affiliation: Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Catherine Brawn
authors.initials: CB
authors.lastname: Fortier
authors.affiliation: *Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts.|Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Higgins
authors.affiliation: Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.|Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Rudolph
authors.affiliation: Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: William P
authors.initials: WP
authors.lastname: Milberg
authors.affiliation: Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.|Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Regina E
authors.initials: RE
authors.lastname: McGlinchey
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001924:Brain Concussion / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D059350:Chronic Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends; D014728:Veterans / Q000523:psychology; D055815:Young Adult
keywords: Chronic Pain; Post-Traumatic Stress Disorder; Traumatic Brain Injury