Persistent Pain and Comorbidity Among Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans
Persistent Pain and Comorbidity Among Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans
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DOI：
10.1111/pme.12388
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发表时间：
2014-05-01
期刊：
影响因子：
3.1
通讯作者：
Goulet, Joseph L.
中科院分区：
文献类型：
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作者：
Higgins, Diana M.;Kerns, Robert D.;Goulet, Joseph L.
慢性疼痛是退伍军人健康管理局(VHA)非常关注的问题，慢性疼痛是持久自由行动(OEF)/伊拉克自由行动(OIF)/新黎明行动(OND)退伍军人最常报告的情况之一。本研究检查了VHA电子病历数据，以检查人口统计学和高患病率和高影响的医疗和心理健康状况的变化，以表征持续性疼痛和无疼痛患者之间的差异。设计采用基于多个疼痛指标(即疼痛强度分级、处方阿片类药物、疼痛诊所就诊、国际疾病分类、第九版修订代码)的保守的操作定义。分析包括使用VHA护理的OEF/OIF/OND退伍军人的整个纵向临床数据，以比较那些有持续性疼痛的人和那些没有临床疼痛证据的人。结果Logistic回归模型的结果表明，性别、种族、教育程度、军事变量、体重指数(BMI)、创伤性脑损伤(TBI)和心理健康状况(而不是年龄)可以可靠地区分两组。持续性疼痛患者多为黑人、女性、现役、应征入伍、军人、高中及以下文化程度，有情绪障碍、创伤后应激障碍、物质使用障碍、焦虑症、脑外伤的诊断，且BMI与超重和肥胖相一致。结论本研究提出的慢性疼痛的操作定义对检验事件和慢性疼痛的预测因素具有一定的研究意义。这些数据具有重要的临床意义，因为解决持续性疼痛的并存状况可能会改善这些患者的适应性应对和功能。
ObjectiveChronic pain is a significant concern for the Veterans Health Administration (VHA), with chronic pain conditions among those most frequently reported by Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) veterans. The current study examined VHA electronic medical record data to examine variation in demographics and high prevalence and high impact medical and mental health conditions in order to characterize the differences between patients with persistent pain and no pain.DesignA conservative operational definition of chronic or persistent pain based on multiple indicators of pain (i.e., pain intensity ratings, prescription opioids, pain clinic visits, International Classification of Diseases, Ninth Revision codes) was employed. Analyses included the entire roster of longitudinal clinical data on OEF/OIF/OND veterans who used VHA care to compare those with persistent pain with those with no clinical evidence of pain.ResultsResults of logistic regression models suggest that sex, race, education, military variables, body mass index (BMI), traumatic brain injury (TBI), and mental health conditions, but not age, reliably discriminate the two groups. Those with persistent pain were more likely to be Black, female, on active duty, enlisted, Army service members, have a high school education or less, and have diagnoses of mood disorders, post-traumatic stress disorder, substance use disorders, anxiety disorders, TBI, and have a BMI consistent with overweight and obesity.ConclusionsThe operational definition of chronic pain used in this study may have research implications for examining predictors of incident and chronic pain. These data have important clinical implications in that addressing comorbid conditions of persistent pain may improve adaptive coping and functioning in these patients.