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Lakshman R, Tomlinson E, Bucknall T. A Systematic Review of Chronic Pain Management Interventions Among Veterans of Recent Wars and Armed Conflicts. Pain Manag Nurs 2024; 25:285-293. [PMID: 38604820 DOI: 10.1016/j.pmn.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES To identify chronic pain management strategies aimed to reduce pain intensity and enhance functional outcomes in veterans of wars and armed conflict. DESIGN Systematic review without meta-analysis. DATA SOURCES Key words "chronic pain," "veterans," and "injuries" were used to search for articles in the MEDLINE, CINAHL, APA PsycInfo, and Embase databases. Articles published in English between 2000 and 2023 were included. REVIEW/ANALYSIS METHODS A systematic literature search was conducted in June 2020, updated in April 2023, and managed using Covidence review software. Inclusion criteria focused on combat-injured veterans with chronic pain, excluding nonveterans and civilians treated for acute or chronic pain. Data from included studies were extracted, summarized, and critically appraised using the 2018 Mixed Methods Appraisal Tool. This review is registered with PROSPERO (CRD42020207435). RESULTS Fourteen studies met the inclusion criteria, with 10 of them supporting nonpharmacological approaches for managing chronic pain among veterans of armed conflicts and wars. Interventions included psychological/behavioral therapies, peer support, biofeedback training via telephone-based therapy, manual therapy, yoga, cognitive processing therapy, cognitive-behavioral therapy, and social and community integration to reduce pain intensity and enhance functional outcomes. CONCLUSION Nonpharmacological treatments for chronic pain have increased in recent years, a shift from earlier reliance on pharmacological treatments. More evidence from randomized controlled trials on the benefits of combined pain interventions could improve pain management of veterans with complex care needs.
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Affiliation(s)
- Rital Lakshman
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
| | - Emily Tomlinson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia. https://twitter.com/emjane88
| | - Tracey Bucknall
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Alfred Health Partnership, Melbourne, Victoria, Australia. https://twitter.com/nursedecisions
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2
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Patel M, Jomy J, Couban RJ, Scelleur HL, Busse JW. Transition Needs Among Veterans Living With Chronic Pain: A Systematic Review. Mil Med 2024; 189:556-565. [PMID: 37675856 DOI: 10.1093/milmed/usad363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/07/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION A third of Canadian Armed Forces veterans report difficulty adjusting to post-military life. Moreover, an estimated 40% of Canadian veterans live with chronic pain, which is likely associated with greater needs during the transition from military to civilian life. This review explores challenges and transition needs among military personnel living with chronic pain as they return to civilian life. METHODS We searched MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science from inception to July 2022, for qualitative, observational, and mixed-method studies exploring transition needs among military veterans released with chronic pain. Reviewers, working independently and in duplicate, conducted screening and used a standardized and pilot-tested data collection form to extract data from all included studies. Content analysis was used to create a coding template to identify patterns in challenges and unmet needs of veterans transitioning to civilian life, and we summarized our findings in a descriptive manner. RESULTS Of 10,532 unique citations, we identified 43 studies that reported transition challenges and needs of military personnel; however, none were specific to individuals released with chronic pain. Most studies (41 of 43; 95%) focused on military personnel in general, with one study enrolling individuals with traumatic brain injury and another including homeless veterans. We identified military-to-civilian challenges in seven areas: (1) identity, (2) interpersonal interactions/relationships, (3) employment, (4) education, (5) finances, (6) self-care and mental health, and (7) accessing services and care. CONCLUSIONS Military personnel who transition to civilian life report several important challenges; however, the generalizability to individuals released with chronic pain is uncertain. Further research is needed to better understand the transition experiences of veterans with chronic pain to best address their needs and enhance their well-being.
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Affiliation(s)
- Mansi Patel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8, Canada
- Michael G. DeGroote National Pain Centre, McMaster University, MDCL-2101, Hamilton, Ontario L8S 4L8, Canada
| | - Jane Jomy
- Temerty Faculty of Medicine, University of Torontor, Toronto, Ontario M5S 1A8, Canada
| | - Rachel J Couban
- Michael G. DeGroote National Pain Centre, McMaster University, MDCL-2101, Hamilton, Ontario L8S 4L8, Canada
| | - Hélène Le Scelleur
- Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8, Canada
- Michael G. DeGroote National Pain Centre, McMaster University, MDCL-2101, Hamilton, Ontario L8S 4L8, Canada
- Department of Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Ontario L8S 4L8, Canada
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3
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Omar S, Nixon S, Colantonio A. Integrated Care Pathways for Black Persons With Traumatic Brain Injury: A Critical Transdisciplinary Scoping Review of the Clinical Care Journey. TRAUMA, VIOLENCE & ABUSE 2023; 24:1254-1281. [PMID: 34915772 DOI: 10.1177/15248380211062221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Objectives: This novel critical transdisciplinary scoping review examined the literature on integrated care pathways that consider Black people living with traumatic brain injury (TBI). The objectives were to (a) summarize the extent, nature, and range of literature on care pathways that consider Black populations, (b) summarize how Blackness, race, and racism are conceptualized in the literature, (c) determine how Black people come to access care pathways, and (d) identify how care pathways in research consider the mechanism of injury and implications for human occupation. Methods: Six databases were searched systematically identifying 178 articles after removing duplicates. In total, 43 articles on integrated care within the context of Black persons with TBI were included. Narrative synthesis was conducted to analyze the data and was presented as descriptive statistics and as a narrative to tell a story. Findings: All studies were based in the United States where 81% reported racial and ethnic disparities across the care continuum primarily using race as a biological construct. Sex, gender, and race are used as demographic variables where statistical data were stratified in only 9% of studies. Black patients are primarily denied access to care, experience lower rates of protocol treatments, poor quality of care, and lack access to rehabilitation. Racial health disparities are disconnected from racism and are displayed as symptoms of a problem that remains unnamed. Conclusion: The findings illustrate how racism becomes institutionalized in research on TBI care pathways, demonstrating the need to incorporate the voices of Black people, transcend disciplinary boundaries, and adopt an anti-racist lens to research.
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Affiliation(s)
- Samira Omar
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Stephanie Nixon
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
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4
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Etchin AG, Fonda JR, Howard EP, Fortier CB, Milberg WP, Pounds K, McGlinchey RE. Childhood Trauma Differentially Impacts Depression and Stress Associations with Reintegration Challenges Among Post-9/11 U.S. Veterans. Nurs Outlook 2021; 70:323-336. [PMID: 34895737 DOI: 10.1016/j.outlook.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/30/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Post-9/11 veterans exhibit high prevalence of deployment stress, psychological conditions, and traumatic brain injury (TBI) which impact reintegration, especially among those with a history of interpersonal early life trauma (I-ELT). The relative importance of each risk factor is unclear. PURPOSE We examined major deployment and clinical exposures of reintegration challenges among veterans with and without I-ELT. METHOD We analyzed cross-sectional data of 155 post-9/11 veterans from the Translational Research Center for TBI and Stress Disorders study. FINDINGS Depression severity had the strongest association with reintegration challenges, followed by posttraumatic stress disorder (PTSD) severity, post-deployment stress, and deployment safety concerns. Deployment safety concerns had a stronger, significant association among veterans with I-ELT. In nearly every model, PTSD and depression severities were weaker for veterans with I-ELT, compared to those without. DISCUSSION Clinicians should consider the relative risk of concurrent clinical conditions and trauma histories when considering veterans' reintegration needs.
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Affiliation(s)
- Anna G Etchin
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System, Boston, MA.
| | - Jennifer R Fonda
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University Medical Campus, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Elizabeth P Howard
- Connell School of Nursing, Boston College, Chestnut Hill, MA; The Hinda and Arthur Marcus Institute for Aging Research (The Marcus Institute), Hebrew Senior Life, Boston, MA
| | - Catherine B Fortier
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - William P Milberg
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Karen Pounds
- College of Nursing and Health Sciences, University of Massachusetts Dartmouth, North Dartmouth, MA
| | - Regina E McGlinchey
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA
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5
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Kersey J, Terhorst L, Heinemann AW, Hammel J, Baum C, McCue M, Skidmore ER. Construct validity of the enfranchisement scale of the community participation indicators. Clin Rehabil 2021; 36:263-271. [PMID: 34414799 DOI: 10.1177/02692155211040930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examined the construct validity of the Enfranchisement scale of the Community Participation Indicators. DESIGN We conducted a secondary analysis of data collected in a cross-sectional study of rehabilitation outcomes. SUBJECTS The parent study included 604 community-dwelling adults with chronic traumatic brain injury, stroke, or spinal cord injury. The sample had a mean age of 64.1 years, was two-thirds male, and included a high proportion of racial minorities (n = 250, 41.4%). MAIN MEASURES The Enfranchisement scale contains two subscales: the Control subscale and the Importance subscale. We examined correlations between each Enfranchisement subscale and measures of participation, environment, and impairments. The current analyses included cases with at least 80% of items completed on each subscale (Control subscale: n = 391; Importance subscale: n = 219). Missing values were imputed using multiple imputation. RESULTS The sample demonstrated high scores, indicating poor enfranchisement (Control subscale: M = 51.7; Importance subscale: M = 43.0). Both subscales were most strongly associated with measures of participation (Control subscale: r = 0.56; Importance subscale: r = 0.52), and least strongly associated with measures of cognition (Control subscale: r = 0.03; Importance subscale: r = 0.03). The Importance subscale was closely associated with depression (r = 0.54), and systems, services, and policies (r = 0.50). Both subscales were associated with social attitudes (Control subscale: r = 0.44; Importance subscale: r = 0.44) and social support (Control subscale: r = 0.49; Importance subscale: r = 0.41). CONCLUSIONS We found evidence of convergent validity between the Enfranchisement scale and measures of participation, and discriminant validity between the Enfranchisement scale and measures of disability-related impairments. The analyses also revealed the importance of the environment to enfranchisement outcomes.
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Affiliation(s)
- Jessica Kersey
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Carolyn Baum
- Program in Occupational Therapy and Departments of Neurology & Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
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6
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Vogt D, King MW, Borowski S, Finley EP, Perkins DF, Copeland LA. Identifying factors that contribute to military veterans' post-military well-being. Appl Psychol Health Well Being 2021; 13:341-356. [PMID: 33595207 DOI: 10.1111/aphw.12252] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/20/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
Prior research has examined the independent effects of demographic and military characteristics, trauma history, and coping resources on military veterans' health. However, there is limited knowledge of how these factors intersect with one another and with veterans' health to impact their broader well-being as they readjust to civilian life. Data for this study were drawn from a longitudinal investigation of the health and broader well-being of U.S. veterans (N = 7150) who had recently left military service. Machine learning analyses (random forests of regression trees) were used to examine how factors assessed shortly after military separation were associated with veterans' well-being approximately a year later. Veterans who endorsed the combination of low depression, high social support, and high psychological resilience were most likely to report high well-being a year later. Neither demographic and military characteristics nor trauma history emerged as strong predictors of veterans' well-being when considered in the context of other factors. Although most predictors were similar for women and men, depression was a stronger predictor of women's well-being. Results highlight the importance of screening for and intervening with veterans who report high depression, low social support, and low psychological resilience when leaving military service. These findings can inform efforts to promote veterans' post-military well-being.
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Affiliation(s)
- Dawne Vogt
- Women's Health Sciences Division, National Center for PTSD (116B-3), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Matthew W King
- Women's Health Sciences Division, National Center for PTSD (116B-3), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Shelby Borowski
- Women's Health Sciences Division, National Center for PTSD (116B-3), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Erin P Finley
- Veterans Evidence-Based Research Dissemination and Implementation Center, South Texas Veterans Healthcare System, San Antonio, Texas, USA.,Departments of Medicine and Psychiatry, UT Health San Antonio, San Antonio, Texas, USA
| | - Daniel F Perkins
- Clearinghouse for Military Family Readiness, Pennsylvania State University, State College, Pennsylvania, USA.,Department of Agricultural Economics, Sociology, and Education, Pennsylvania State University, State College, Pennsylvania, USA.,Social Science Research Institute, Pennsylvania State University, State College, Pennsylvania, USA
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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A Scoping Review of Predictors of Community Integration Following Traumatic Brain Injury: A Search for Meaningful Associations. J Head Trauma Rehabil 2020; 34:E32-E41. [PMID: 30499925 DOI: 10.1097/htr.0000000000000442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this scoping review was to identify predictors of community integration for adults with traumatic brain injury. DATA SOURCES We searched the PubMed and PsycINFO databases and reviewed references of included studies. We selected studies exploring multiple components of community integration, including instrumental activities of daily living, leisure activities, and social activities. A total of 53 studies were included. DATA EXTRACTION We extracted data on sample size and sample characteristics (stage of injury and recovery, severity) and examined predictor variables, outcome measures for community integration, and significant findings, reported as correlations. DATA SYNTHESIS We found that the predictors of community integration fell into 4 categories: demographics, injury characteristics, disability and impairments, and environmental factors. There was large variability in reported relationships for demographics (r = 0.01-0.43), injury characteristics (r = 0.01-0.58), disability/functional impairments (r = 0.003-0.98) and environmental factors (r = 0.11-0.58). Cognition, disability, mobility/physical functioning, mood, social support, and length of posttraumatic amnesia had the strongest relationships with community integration outcomes. CONCLUSIONS Strategies for the management of cognitive, physical, and emotional functioning, and building and training a strong support system, may facilitate community integration outcomes. Additional work is warranted to further explore the discrepancies found among studies.
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8
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Mamon D, Scoglio AAJ, Calixte RM, Tuval-Mashiach R, Patton B, Drebing CE. Connecting Veterans and Their Community Through Narrative: Pilot Data on a Community Strengthening Intervention. Community Ment Health J 2020; 56:804-813. [PMID: 31907805 DOI: 10.1007/s10597-019-00540-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Abstract
Military personnel transitioning to civilian life commonly report difficulty with establishing friendships, reconnecting with family, and a greater sense that they do not "fit in." Personal narrative interventions have the potential to increase the community's interest and understanding of Veterans' experience. This study examines the impact of a narrative intervention in which Veterans used film or verbal storytelling to describe their experience of being a Veteran to civilian audiences. A total 12 Veterans participated in at least one performance, and 88 community audience members attended one of six performances of the Veterans' narratives. Survey data indicate increase in positive attitudes towards Veterans, as well as a shift in the Veterans' perspective of civilians as receptive and supportive. These preliminary findings suggest that narrative interventions appear to have a positive impact on civilians' interest in Veterans and therefore, may be a valuable community reintegration intervention.
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Affiliation(s)
- Daria Mamon
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program and Harvard Medical School, Boston, MA, USA. .,The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA. .,One Constitution Wharf, Suite 140, Charlestown, MA, 02129, USA.
| | - Arielle A J Scoglio
- The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
| | - Rachelle M Calixte
- The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
| | | | | | - Charles E Drebing
- The Social and Community Reintegration Research Program, ENRM VA Medical Center, Bedford, MA, USA
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9
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Waid-Ebbs JK, Wen PS, Graham DP, Leroux AJ, O’Connor MK, Helmer DA. Measurement Properties of the MPAI-4 in Veterans With mTBI. Arch Phys Med Rehabil 2020; 101:789-796. [DOI: 10.1016/j.apmr.2019.10.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
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10
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Salduker S, Allers E, Bechan S, Hodgson RE, Meyer F, Meyer H, Smuts J, Vuong E, Webb D. Practical approach to a patient with chronic pain of uncertain etiology in primary care. J Pain Res 2019; 12:2651-2662. [PMID: 31564957 PMCID: PMC6731975 DOI: 10.2147/jpr.s205570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic pain of uncertain etiology often presents a challenge to both patients and their health care providers. It is a complex condition influenced by structural and physiological changes in the peripheral and central nervous systems, and it directly influences, and is modulated by, psychological well-being and personality style, mood, sleep, activity level and social circumstances. Consequently, in order to effectively treat the pain, all of these need to be evaluated and addressed. An effective management strategy takes a multidisciplinary biopsychosocial approach, with review of all current medications and identification and careful withdrawal of those that may actually be contributing to ongoing pain. The management approach is primarily nonpharmacological, with carefully considered addition of medication, beginning with pain-modulating treatments, if necessary. In this article, we present a primary care approach to the assessment and management of a patient with chronic pain where the cause cannot be identified.
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Affiliation(s)
| | - Eugene Allers
- Glynview Multiprofessional Practice, Gauteng, South Africa
| | - Sudha Bechan
- Department of Anaesthesiology, Head Clinical Unit, Inkosi Albert Luthuli Central Hospital, Nelson R Mandela School of Medicine, Durban, South Africa
| | - R Eric Hodgson
- Inkosi Albert Luthuli Central Hospital, Nelson R Mandela School of Medicine, Durban, South Africa
| | - Fanie Meyer
- Optima Psychiatric Hospital, Bloemfontein, South Africa
| | - Helgard Meyer
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa.,Wilgers MR & Medical Centre, Pretoria, South Africa
| | - Johan Smuts
- Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| | - Eileen Vuong
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - David Webb
- Houghton House Group, Gauteng, South Africa
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11
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Adams RS, Thomas CP, Ritter GA, Lee S, Saadoun M, Williams TV, Larson MJ. Predictors of Postdeployment Prescription Opioid Receipt and Long-term Prescription Opioid Utilization Among Army Active Duty Soldiers. Mil Med 2019; 184:e101-e109. [PMID: 30007291 DOI: 10.1093/milmed/usy162] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/10/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction Little is known about long-term prescription opioid utilization in the Military Health System. The objectives of this study were to examine predictors of any prescription opioid receipt, and predictors of long-term opioid utilization among active duty soldiers in the year following deployment. Materials and Methods The analytic sample consisted of Army active duty soldiers returning from deployment to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn in fiscal years 2008-2014 (N = 540,738). The Heckman probit procedure was used to jointly examine predictors of any opioid prescription receipt and long-term opioid utilization (i.e., an episode of 90 days or longer where days-supply covered at least two-thirds of days) in the postdeployment year. Predictors were based on diagnoses and characteristics of opioid prescriptions. Results More than one-third of soldiers (34.8%, n = 188,211) had opioid receipt, and among those soldiers, 3.3% had long-term opioid utilization (or 1.1% of the cohort, n = 6,188). The largest magnitude predictors of long-term opioid utilization were receiving a long-acting opioid within the first 30 days of the episode, diagnoses of chronic pain (no specified source), back/neck pain, or peripheral/central nervous system pain, and severe pain score in vital records. Conclusions Soldiers returning from deployment were more likely to receive an opioid prescription than the overall active duty population, and 1.1% initiated a long-term opioid episode. We report a declining rate of opioid receipt and long-term opioid utilization among Army members from fiscal years 2008-2014. This study demonstrates that the most important predictors of opioid receipt were not demographic factors, but generally clinical indicators of acute pain or physical trauma.
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Affiliation(s)
- Rachel Sayko Adams
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA
| | - Cindy Parks Thomas
- Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA
| | - Grant A Ritter
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA
| | - Sue Lee
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA
| | - Mayada Saadoun
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA
| | | | - Mary Jo Larson
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA
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12
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Bouferguène S, Lapierre A, Houzé B, Rainville P, Arbour C. Chronic Central Pain Among Community-Dwelling Survivors of Moderate-to-Severe Traumatic Brain Injury: A Quantitative Sensory Testing Study. Biol Res Nurs 2019; 21:519-531. [DOI: 10.1177/1099800419859078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Central pain associated with changes in sensory thresholds is one of the most enduring consequences of major trauma. Yet it remains sparsely studied among community-dwelling survivors of moderate-to-severe traumatic brain injury (TBI). Purpose: To describe and compare thermal and mechanical sensory thresholds in home-based patients with and without central pain after moderate-to-severe TBI with a cohort of healthy controls. Design: Cross-sectional. Method: Thresholds for cold/heat detection, thermal pain, touch, and distorted sensation were gathered using quantitative sensory testing (QST). QST was performed on the painful and contralateral pain-free body regions in TBI participants with pain (TBI-P) and on both forearms in TBI participants without pain (TBI-NP) and healthy controls (HC). Central pain was characterized using the Brief Pain Inventory–Short Form. Results: We tested 16 TBI-P patients, 17 TBI-NP patients, and 16 HC. Mean time since injury for TBI patients was 24 ± 15 months. TBI-P and TBI-NP patients showed significant loss in innocuous mechanical sensitivity compared to HC ( F = 18.929; Bonferroni-adjusted p ≤ .001). Right–left differences in cold pain sensations were significantly larger in TBI-P than in TBI-NP and HC participants ( F = 14.352; Bonferroni-adjusted p ≤ .001). Elevated heat sensitivity thresholds were also observed in TBI-P participants but remained within normal range. Conclusion: Damage to cutaneous mechanoreceptors is a necessary, but not sufficient, condition for the development of chronic central pain following TBI. Damage or incomplete recovery of cutaneous thermoreceptors may be a contributing factor to chronic pain after TBI.
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Affiliation(s)
- Sabrina Bouferguène
- Research Center and Trauma Division, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Alexandra Lapierre
- Research Center and Trauma Division, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Bérengère Houzé
- Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - Pierre Rainville
- Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - Caroline Arbour
- Research Center and Trauma Division, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
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13
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Esterman M, Fortenbaugh FC, Pierce ME, Fonda JR, DeGutis J, Milberg W, McGlinchey R. Trauma-related psychiatric and behavioral conditions are uniquely associated with sustained attention dysfunction. Neuropsychology 2019; 33:711-724. [PMID: 31144830 DOI: 10.1037/neu0000525] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE It is increasingly recognized that trauma victims, particularly Veterans, have co-occurring psychological and physical conditions that impact cognition, especially the domains of sustained attention and executive functioning. Although previous work has generally attempted to isolate the unique cognitive effects of common combat-related comorbidities, less work has been done to examine how these conditions co-occur, and whether unique cognitive signatures accompany certain clinical combinations. METHOD To address this gap, we examined how several deployment-related conditions were associated with performance on a well-validated measure of sustained attention (i.e., gradual onset continuous performance task [gradCPT]) and a battery of standard neuropsychological measures in 123 Veterans from the Translational Research Center for TBI and Stress Disorders. Initially, a Principal component analysis was conducted to investigate how comorbid conditions grouped together. RESULTS Several sustained attention measures from the gradCPT were differentially associated with four unique combinations of trauma-related pathology. Specifically, a somatic component representing the combination of current pain, sleep disturbance, and mild traumatic brain injury was associated with a higher rate of failures of attentional engagement. On the other hand, a comorbid posttraumatic stress disorder (PTSD) and mood disorder component (moodPTSD), as well as a substance use disorder component, were associated with higher rates of inhibitory control failures. Increased attentional instability was associated with moodPTSD as well as an anxiety disorder component. In contrast, the cognitive effects of deployment-related trauma were not observed on standard neuropsychological measures. CONCLUSION These findings suggest that unique combinations of trauma-related pathology have dissociable effects on sustained attentional control. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Joseph DeGutis
- Translational Research Center for TBI and Stress Disorders
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14
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Veteran Coffee Socials: A Community-Building Strategy for Enhancing Community Reintegration of Veterans. Community Ment Health J 2018; 54:1189-1197. [PMID: 29948629 DOI: 10.1007/s10597-018-0288-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
Veterans transitioning from military to civilian life are vulnerable to a loss of social support and an increase in isolation from their communities, which can exacerbate other difficulties they may be experiencing, such as physical or mental health problems. Veteran Coffee Socials are an innovative community-building pilot intervention designed to foster social support and community between veterans. In seven target communities, certified peer specialists initiated and facilitated weekly "Veteran Coffee Socials"-open peer support groups for veterans, held in local coffee shop or restaurants. Over a 9-month period, an average of 8.5 veterans attended each meeting, for a total of 2236 veteran engagements across seven towns. A range of activities were identified as commonly occurring during these Veteran Coffee Socials. Veteran attendees routinely formed relationships with each other, representatives from community organizations, and staff from local and VA healthcare resources. One of the most common activities involved veterans receiving information and directions for enrollment into needed healthcare supports and to local community resources. Case descriptions are provided illustrate the potential positive impact of this intervention to build community and expand social support for returning veterans through the examination of three individual and three group examples.
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15
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Wickwire EM, Schnyer DM, Germain A, Williams SG, Lettieri CJ, McKeon AB, Scharf SM, Stocker R, Albrecht J, Badjatia N, Markowitz AJ, Manley GT. Sleep, Sleep Disorders, and Circadian Health following Mild Traumatic Brain Injury in Adults: Review and Research Agenda. J Neurotrauma 2018; 35:2615-2631. [PMID: 29877132 DOI: 10.1089/neu.2017.5243] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A rapidly expanding scientific literature supports the frequent co-occurrence of sleep and circadian disturbances following mild traumatic brain injury (mTBI). Although many questions remain unanswered, the preponderance of evidence suggests that sleep and circadian disorders can result from mTBI. Among those with mTBI, sleep disturbances and clinical sleep and circadian disorders contribute to the morbidity and long-term sequelae across domains of functional outcomes and quality of life. Specifically, along with deterioration of neurocognitive performance, insufficient and disturbed sleep can precede, exacerbate, or perpetuate many of the other common sequelae of mTBI, including depression, post-traumatic stress disorder, and chronic pain. Further, sleep and mTBI share neurophysiologic and neuroanatomic mechanisms that likely bear directly on success of rehabilitation following mTBI. For these reasons, focus on disturbed sleep as a modifiable treatment target has high likelihood of improving outcomes in mTBI. Here, we review relevant literature and present a research agenda to 1) advance understanding of the reciprocal relationships between sleep and circadian factors and mTBI sequelae and 2) advance rapidly the development of sleep-related treatments in this population.
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Affiliation(s)
- Emerson M Wickwire
- 1 Department of Psychiatry, University of Maryland School of Medicine , Baltimore, Maryland.,2 Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland
| | - David M Schnyer
- 3 Department of Psychology, University of Texas , Austin, Texas
| | - Anne Germain
- 4 Department of Psychiatry, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Scott G Williams
- 5 Sleep Disorders Center, Department of Medicine, Walter Reed National Military Medical Center , Bethesda, Maryland.,6 Department of Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Christopher J Lettieri
- 5 Sleep Disorders Center, Department of Medicine, Walter Reed National Military Medical Center , Bethesda, Maryland.,6 Department of Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Ashlee B McKeon
- 4 Department of Psychiatry, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Steven M Scharf
- 2 Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine , Baltimore, Maryland
| | - Ryan Stocker
- 7 University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Jennifer Albrecht
- 8 Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, Maryland
| | - Neeraj Badjatia
- 9 Department of Neurology, University of Maryland School of Medicine , Baltimore, Maryland
| | - Amy J Markowitz
- 10 UCSF Brain and Spinal Injury Center , San Francisco, California
| | - Geoffrey T Manley
- 11 Department of Neurosurgery, University of California , San Francisco, California
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16
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Mehalick ML, Glueck AC. Examining the relationship and clinical management between traumatic brain injury and pain in military and civilian populations. Brain Inj 2018; 32:1307-1314. [PMID: 29993307 DOI: 10.1080/02699052.2018.1495339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In this review, we discuss the comorbidity of traumatic brain injury (TBI) and pain among civilians and military members, the common causes of pain resulting from TBI, and offer insight about the therapeutic management of TBI symptoms and pain. Traumatic brain injury (TBI) is a debilitating health problem and one of the most common post-TBI symptoms is pain, which can contribute to psychological issues such as Post-traumatic stress disorder (PTSD) and depression. Headache pain appears to be the most common type of pain that results from TBI, yet pain can also be more widespread. Managing TBI symptoms and pain simultaneously is difficult because extensive randomized control and clinical studies assessing the effectiveness of therapeutic approaches are lacking. Pharmacological agents such as antidepressants and Triptans and nonpharmacological therapies such as cognitive rehabilitation and physical therapies are commonly used yet it is unknown how effective these therapies are in the long-term. A combination of pharmacological and non-pharmacological therapies is often more effective for managing TBI symptoms and pain than either treatment alone. However, future research is needed to determine the most therapeutic approaches for managing the comorbidity of pain and TBI symptoms in the long term. This review offers suggestions for such future studies.
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Affiliation(s)
- Melissa L Mehalick
- a Department of Neurotrauma, Operational and Undersea Medicine Directorate , Naval Medical Research Center , Silver Spring , MD, USA
| | - Amanda C Glueck
- b Sports Medicine Research Institute , University of Kentucky , Lexington , KY, USA
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17
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Leung A, Metzger-Smith V, He Y, Cordero J, Ehlert B, Song D, Lin L, Shahrokh G, Tsai A, Vaninetti M, Rutledge T, Polston G, Sheu R, Lee R. Left Dorsolateral Prefrontal Cortex rTMS in Alleviating MTBI Related Headaches and Depressive Symptoms. Neuromodulation 2017; 21:390-401. [DOI: 10.1111/ner.12615] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/22/2017] [Accepted: 04/10/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Albert Leung
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | | | - Yifan He
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - James Cordero
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Brandon Ehlert
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - David Song
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Neuroscience; The University of California; San Diego, La Jolla, CA, USA
| | - Lisa Lin
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | | | - Alice Tsai
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Michael Vaninetti
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Thomas Rutledge
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Psychiatric; The University of California; San Diego, La Jolla, CA, USA
| | - Greg Polston
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Robert Sheu
- Naval Medical Center San Diego; San Diego, CA, USA
| | - Roland Lee
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Radiology; The University of California; San Diego, La Jolla, CA, USA
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18
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Denhardt DT. Effect of stress on human biology: Epigenetics, adaptation, inheritance, and social significance. J Cell Physiol 2017; 233:1975-1984. [PMID: 28158904 DOI: 10.1002/jcp.25837] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 12/21/2022]
Abstract
I present a brief introduction to epigenetics, focused primarily on methylation of the genome and various regulatory RNAs, modifications of associated histones, and their importance in enabling us to adapt to real and changing environmental, developmental, and social circumstances. Following this is a more extensive overview of how it impacts our inheritance, our entire life (which changes as we age), and how we interact with others. Throughout, I emphasize the critical influence that stress, of many varieties exerts, via epigenetic means, on much of how we live and survive, mostly in the brain. I end with a short section on multigenerational transmission, drugs, and the importance of both social life and early life experiences in the development of adult diseases. There will be nothing about cancer. Although epigenetics is critical in that field, it is a whole different cobweb of complications (some involving stress).
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Affiliation(s)
- David T Denhardt
- Division of Life Sciences, Rutgers University, New Brunswick, New Jersey
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19
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Abstract
This article reviews possible ways that traumatic brain injury (TBI) can induce migraine-type post-traumatic headaches (PTHs) in children, adults, civilians, and military personnel. Several cerebral alterations resulting from TBI can foster the development of PTH, including neuroinflammation that can activate neural systems associated with migraine. TBI can also compromise the intrinsic pain modulation system and this would increase the level of perceived pain associated with PTH. Depression and anxiety disorders, especially post-traumatic stress disorder (PTSD), are associated with TBI and these psychological conditions can directly intensify PTH. Additionally, depression and PTSD alter sleep and this will increase headache severity and foster the genesis of PTH. This article also reviews the anatomic loci of injury associated with TBI and notes the overlap between areas of injury associated with TBI and PTSD.
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20
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Leung A, Shukla S, Fallah A, Song D, Lin L, Golshan S, Tsai A, Jak A, Polston G, Lee R. Repetitive Transcranial Magnetic Stimulation in Managing Mild Traumatic Brain Injury-Related Headaches. Neuromodulation 2015; 19:133-41. [DOI: 10.1111/ner.12364] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/07/2015] [Accepted: 09/15/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Albert Leung
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Shivshil Shukla
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Amir Fallah
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - David Song
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Lisa Lin
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Shahrokh Golshan
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
- Biostatistics Core; Veterans Medical Research Foundation; San Diego CA USA
| | - Alice Tsai
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Amy Jak
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Greg Polston
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Roland Lee
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
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