1 / 25

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.

britain
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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

  2. 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

  3. 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

  4. 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

  5. There is substantial overlap in symptoms in mTBI, pain, PTSD and SUD

  6. OEF/OIF pain may be more difficult to treat

  7. Pain Change Following Interdisciplinary Treatment 7

  8. Post-Deployment Multi-symptom Disorder TBI/Pain PAIN TBI Post-deployment Multi-symptom Disorder Pain/PTSD TBI/PTSD PTSD CLARK- 2009

  9. 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

  10. 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

  11. Randomsample from OEF/OIF VA registry Biases 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)

  12. Demographics

  13. Deployment

  14. 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%  

  15. Mental Health Problems

  16. Treatment Experience

  17. DSM-IV Mental Health Diagnoses

  18. Diagnostic Overlap

  19. Symptom Burden 1

  20. Symptom Burden 2

  21. Symptom Burden 3

  22. PMD Treatment P3+ PTSD Pain Postconcussion Post-Deployment Behavioral Health Program Substance Abuse 22

  23. P3+Team Staff with specialties in Behavioral Medicine Pain PTSD TBI Substance Abuse Case Management PM&RS therapies 23

  24. 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

  25. 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 25

More Related