A functional restoration program for active duty service members with chronic pain: Examining the impact of co-occurring PTSD on treatment response

Abstract: Introduction: Standard medical intervention for chronic pain may be less effective in the presence of co-occurring PTSD. Functional restoration programs (FRPs), which combine psychological interventions and progressive exercise rehabilitation, represent an alternative to standard medical intervention for chronic pain. The objective of the current study is to evaluate a FRP serving Active Duty Service Members with chronic pain and to examine whether co-occurring PTSD symptoms are associated with differential treatment response. Methods: This is a retrospective observational study of data previously collected at Naval Medical Center San Diego approved by the Naval Medical Center San Diego Institutional Review Board. The study included 81 Active Duty Service Members, primarily Sailors and Marines, who completed a FRP, and examined pre- to post-treatment changes in Pain Impact Score—a composite measure of pain intensity, pain interference, and physical functioning—as well as measures of mental health and pain cognitions. Co-occurring PTSD symptoms were examined as a potential moderator of treatment response. Results: Twenty-three patients (28.4%) screened positive for PTSD during baseline assessments. Repeated measures analysis of variance showed statistically significant improvement in Pain Impact Score for the full sample (P <.001). Although no significant interactions with probable PTSD were demonstrated for measures of pain intensity and physical functioning (both P s >.05), patients screening positive for PTSD demonstrated a lesser decrease in pain interference compared to patients screening negative for PTSD (P <.01). Improvements in measures of mental health and pain cognitions were also statistically significant for the full sample (all P values <.05) and did not differ as a function of PTSD symptoms (all P values >.05). Conclusion: This FRP primarily serving Sailors and Marines contributed to broad overall improvements in the domains of pain and functioning as well as mental health and pain cognitions. Co-occurring PTSD symptoms were not associated with poorer treatment response on most measured outcomes.

Read the full article
Report a problem with this article

Related articles

  • More for Researchers

    Identifying opioid relapse during COVID-19 using natural language processing of nationwide Veterans Health Administration electronic medical record data

    Abstract: Novel and automated means of opioid use and relapse risk detection are needed. Unstructured electronic medical record data, including written progress notes, can be mined for clinically relevant information, including the presence of substance use and relapse-critical markers of risk and recovery from opioid use disorder (OUD). In this study, we used natural language processing (NLP) to automate the extraction of opioid relapses, and the timing of these occurrences, from veteran patients' electronic medical record. We then demonstrated the utility of our NLP tool via analysis of pre-/post-COVID-19 opioid relapse trends among veterans with OUD. For this demonstration, we analyzed data from 107,606 veterans OUD enrolled in Veterans Health Administration, comparing a pandemic-exposed cohort (n = 53,803; January 2019-March 2021) to a matched prepandemic cohort (n = 53,803; October 2017-December 2019). The recall of our NLP tool was 75% and our precision was 94%, demonstrating moderate sensitivity and excellent specificity. Using the NLP tool, we found that the odds of opioid relapse postpandemic onset were proportionally higher compared to prepandemic trends, despite patients having fewer mental health encounters from which to derive instances of relapse postpandemic onset. In this research application of the tool, and as hypothesized, we found that opioid relapse risk was elevated postpandemic. The application of NLP Methods: to identify and monitor relapse risk holds promise for future surveillance, risk prevention, and clinical outcome research.

    Mental Health Peer reviewed