Defense and Veterans Brain Injury Center, Silver Spring, MD 20910, USA.
Department of Physical Medicine and Rehabilitation, Hunter Holmes McGuire Department of Veterans Affairs Medical Center, Richmond, VA 23249, USA.
Mil Med. 2021 Feb 26;186(3-4):e293-e299. doi: 10.1093/milmed/usaa249.
Chronic pain is a significant problem for service members and veterans with mild traumatic brain injury (mTBI). While the root cause of pain is not clearly understood, comorbidities may contribute to how their pain disrupts their functional status, a construct termed "pain interference." The purpose of this study is to examine the associations between mTBI, other comorbidities, and pain interference.
The sample comprised participants with mTBI(s) from The Chronic Effects of Neurotrauma Consortium multicenter observational study. Potential concussive events were identified using a modified Ohio State University traumatic brain injury (TBI) Identification interview and then further with a structured interview. Pain interference was measured with the TBI quality-of-life pain interference score, which was categorized into insignificant, moderate, and high pain interference. Comorbidities of interest included anxiety, depression, post-traumatic stress disorder, insomnia, and arthritis. Multivariable relationships were analyzed using logistic regression.
The analysis sample included 346 participants with mTBI(s). In adjusted analysis, those with high pain interference were more likely to have history of ≥ 3 TBIs (odds ratio (OR) 3.1, 95% confidence interval [CI] 1.4, 6.9) and to have clinical levels of post-traumatic stress disorder (OR 5.4, 95% CI 1.9, 15.7), depression (OR 2.5, 95% CI, 1.0, 6.1), anxiety (OR 4.9, 95% CI, 2.0, 11.7), and sleep disturbances (OR 6.1, 95% CI 2.0, 19.0) versus those with insignificant pain interference.
These results identify clinical features of veterans and service members with mTBI(s) who are at highest risk for pain-related disability. These findings also demonstrate the need to consider mental health and sleep problems in their pain evaluation and treatment approach.
慢性疼痛是患有轻度创伤性脑损伤（mTBI）的军人和退伍军人的一个严重问题。尽管疼痛的根本原因尚不清楚，但合并症可能会影响其疼痛对功能状态的干扰程度，这一概念称为“疼痛干扰”。本研究的目的是探讨 mTBI、其他合并症与疼痛干扰之间的关系。
该样本包括来自慢性神经创伤后果联盟多中心观察性研究的 mTBI 参与者。使用改良俄亥俄州立大学创伤性脑损伤（TBI）识别访谈识别潜在的震荡事件，然后使用结构化访谈进一步识别。疼痛干扰使用 TBI 生活质量疼痛干扰评分进行测量，该评分分为无显著、中度和高度疼痛干扰。感兴趣的合并症包括焦虑、抑郁、创伤后应激障碍、失眠和关节炎。使用逻辑回归分析多变量关系。
分析样本包括 346 名患有 mTBI 的参与者。在调整后的分析中，那些疼痛干扰程度高的人更有可能有≥3 次 TBI 病史（比值比（OR）3.1，95%置信区间[CI]1.4，6.9）和有临床水平的创伤后应激障碍（OR 5.4，95%CI 1.9，15.7）、抑郁（OR 2.5，95%CI 1.0，6.1）、焦虑（OR 4.9，95%CI 2.0，11.7）和睡眠障碍（OR 6.1，95%CI 2.0，19.0）相比于那些疼痛干扰不显著的人。
这些结果确定了患有 mTBI 的退伍军人和军人中与疼痛相关残疾风险最高的临床特征。这些发现还表明，在评估和治疗疼痛时需要考虑心理健康和睡眠问题。
