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Epidemiology of Pain, PTSD, and Post-concussive Syndrome among OEF/OIF Veterans. Michael E. Clark, Ph.D. Clinical Director, Chronic Pain Rehabilitation Program Chair, VA National Polytrauma Pain Workgroup Departments of Neurology and Psychology, University of South Florida.

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epidemiology of pain ptsd and post concussive syndrome among oef oif veterans

Epidemiology of Pain, PTSD, and Post-concussive Syndrome among OEF/OIF Veterans

Michael E. Clark, Ph.D.

Clinical Director, Chronic Pain Rehabilitation Program

Chair, VA National Polytrauma Pain Workgroup

Departments of Neurology and Psychology, University of South Florida

headache pain is characteristic
Headache Pain is Characteristic
  • Kalra, Clark, & Scholten, 2008
    • 52%of 99 OEF/OIF former service members registered for endorsed the presence of headaches when asked
    • 42% reported headache related interference and averaged 4 headaches per week
  • Ruff, Ruff, & Wang, 2008
    • 63% of a sample of 126 outpatients with mild TBI symptoms reported headaches
    • Among those with cognitive deficits, prevalence of headaches was 92%

2

comorbid mental health conditions are pervasive
Comorbid Mental Health Conditions are Pervasive

65% of PRC inpatients received a mental Health Diagnosis:(Walker & Clark, 2006)

  • Adjustment Disorder: 47%
  • PTSD: 29%
  • Depressive Disorder: 24%
  • Substance Abuse: 7%
  • Acute Stress Disorder: 5%

In a sample of 99 VA medical care registrants 67% reported emotional problems: (Kalra, Clark, Scholten, Murphy, & Clements, 2008)

36% Depression 16% PTSD symptoms

23% Adjustment problems 15% anger control issues

20% Anxiety 12% alcohol abuse

19% Marital or family problems

CLARK- 2009

pain ptsd mtbi and substance use disorders often co occur and interact
Pain, PTSD, mTBI, and substance use disorders often co-occur and interact

*Headaches only. Total pain % not reported but data for separate pain conditions suggests it approaches 100% in these war-injured.

* *Headaches only. Total pain % not reported

CLARK- 2009

post deployment multi symptom disorder
Post-Deployment Multi-symptom Disorder

TBI/Pain

PAIN

TBI

Post-deployment

Multi-symptom

Disorder

Pain/PTSD

TBI/PTSD

PTSD

CLARK- 2009

pmd example
PMD Example

Lew, Otis, Tun, Kerns, Clark, & Cifu, 2009

Sample = 340 OEF/OIF outpatients at Boston VA

TBI/Pain

12.6%

PAIN

TBI

10.3%

Post-deployment

Multi-symptom

Disorder

5.3%

Pain/PTSD

TBI/PTSD

6.8%

16.5%

42.1%

PTSD

Overall prevalence:

Pain 81.5%

TBI 68.2%

PTSD 66.8%

2.9%

CLARK- 2009

latest data
Latest Data
  • HSR&D funded study examining OEF/OIF pain and emotional issues at 2 of the 4 PRC sites
  • Participants recruited either from the polytrauma network of care (convenience) or local OEF/OIF registries (random)
  • Follow all participants for 12 months
  • Approximately 600 data points
  • Utilize validated and accepted structured diagnostic interview for DSM IV diagnoses
  • Following data represent a “first look” at some results for 127 participants
biases
Randomsample from OEF/OIF VA registryBiases

Polytrauma already selected for Tx

Agreed to participate (21%)

PRC/PNS Sample

(n= 69)

OEF/OIF Sample

(n= 52)

Agreed to participate (40%)

Regional effects? (Minneapolis)

Regional effects? (Tampa)

slide14
Pain
  • Persistent pain present in 86.4%, average pain 3.7
    • Significant pain (4 or >)50.4%
  • Headache prevalence 72.5%
    • Days/week with headaches3.6
  • Most common pain locations

Primary Pain Any Pain

  Back 29.9% 75.9%  

Head 29.0% 66.7%  

Shoulder 11.2% 49.1%  

Knee 7.5% 56.5%  

Neck 5.6% 48.1%  

Hand/wrist 4.7% 25.9%  

Ankle/foot 3.8% 25.0%  

Leg/Hip 2.8% 24.1%  

Arm/elbow 1.9% 24.1%  

pmd treatment
PMD Treatment

P3+

PTSD

Pain

Postconcussion

Post-Deployment Behavioral Health Program

Substance Abuse

22

p3 team
P3+Team

Staff with specialties in

Behavioral Medicine

Pain

PTSD

TBI

Substance Abuse

Case Management

PM&RS therapies

23

slide24
P3+ Integrated Care

Post Deployment Clinics

Polytrauma Teams

DoD Facilities

Focused Treatments (existing & expand)

Evaluation/Tx Planning

TBI Tx

Required Core Treatment:

Life Needs (Sleep Hygiene,

Relaxation Skills;

Substance Use)

Pain Tx

New Program

Existing Programs

Optional Core Treatments:

Anger Management

Negative Affect

Cognitive Adaptation

Relationship Enhancement

Work Skills

Physical Conditioning

PTSD Tx

Substance

Abuse Tx

VR Tx

24

where do we go from here
Where do we go from here?.
  • Data, data, data!
    • How do these overlapping comorbidities interact, and does it impact outcomes?
    • What are the most effective and efficient treatments for PMD?
    • What increased health and adjustment risks are associated with blast exposure?
  • Until data become available, develop innovative but rational programs based on existing knowledge and conceptual models

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