Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.
Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA.
J Gen Intern Med. 2024 Aug;39(11):2009-2016. doi: 10.1007/s11606-024-08803-w. Epub 2024 May 23.
The prevalence of co-occurring chronic pain and posttraumatic stress disorder (PTSD) has yet to be established in a nationally representative sample of US veterans, and little is known about the individual contributing roles of these disorders to the psychiatric and functional burden of this comorbidity.
To determine the prevalence of chronic pain, PTSD, and co-occurring chronic pain and PTSD, and psychiatric comorbidities and psychosocial functioning in these groups.
Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of US veterans.
Veterans (n=4069) were classified into four groups: control (i.e., no PTSD or chronic pain), chronic pain only, PTSD only, and co-occurring chronic pain and PTSD.
A probable PTSD diagnosis was established using the PTSD Checklist for DSM-5, and a chronic pain diagnosis using a self-report item that queried health care professional diagnoses. Psychiatric and functional status were assessed using the Patient Health Questionnaire-4, Alcohol Use Disorders Identification Test, Screen of Drug Use, Suicide Behaviors Questionnaire-Revised, Short Form Health Survey-8, Brief Inventory of Psychosocial Functioning, and Medical Outcomes Study Cognitive Functioning Scale.
A total of 3.8% of veterans reported both probable PTSD and a diagnosis of chronic pain. Relative to veterans with chronic pain alone, those with co-occurring chronic pain and probable PTSD were more likely to screen positive for psychiatric disorders (odds ratios [ORs]=2.59-9.88) and scored lower on measures of psychosocial functioning (Cohen's ds=0.38-1.43). Relative to veterans with probable PTSD only, those with co-occurring chronic pain and probable PTSD were more likely to have attempted suicide (OR=4.79; 95%CI, 1.81-12.69).
Results underscore the importance of whole health care that considers a broad range of health and functional domains in the assessment and treatment of co-occurring chronic pain and PTSD in veterans.
在具有代表性的美国退伍军人样本中，慢性疼痛和创伤后应激障碍（PTSD）共存的流行率尚未确定，对于这些疾病对这种共病的精神和功能负担的个体贡献作用知之甚少。
确定慢性疼痛、PTSD、慢性疼痛和 PTSD 共存以及这些组中的精神共病和心理社会功能的患病率。
对来自国家健康和退伍军人复原力研究的数据进行了分析，该研究对具有代表性的美国退伍军人样本进行了调查。
将退伍军人（n=4069）分为四组：对照组（即无 PTSD 或慢性疼痛）、慢性疼痛组、PTSD 组和慢性疼痛和 PTSD 共存组。
使用 DSM-5 PTSD 清单建立可能的 PTSD 诊断，使用询问医疗保健专业人员诊断的自我报告项目建立慢性疼痛诊断。使用患者健康问卷-4、酒精使用障碍识别测试、药物使用筛查、自杀行为问卷修订版、简短健康调查-8、简要心理社会功能量表和医疗结局研究认知功能量表评估精神和功能状态。
共有 3.8%的退伍军人报告同时患有 PTSD 和慢性疼痛。与仅患有慢性疼痛的退伍军人相比，同时患有慢性疼痛和 PTSD 的退伍军人更有可能出现精神障碍筛查阳性（优势比[OR] = 2.59-9.88），心理社会功能测量得分较低（Cohen's ds = 0.38-1.43）。与仅患有 PTSD 的退伍军人相比，同时患有慢性疼痛和 PTSD 的退伍军人更有可能自杀（OR=4.79；95%CI，1.81-12.69）。
研究结果强调了整体医疗保健的重要性，在评估和治疗退伍军人的慢性疼痛和 PTSD 共病时，应考虑广泛的健康和功能领域。
