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Sullivan MD, Wilson L, Amick M, Miller-Matero LR, Chrusciel T, Salas J, Zabel C, Lustman PJ, Ahmedani B, Carpenter RW, Scherrer JF. Social support and the association between post-traumatic stress disorder and risk for long-term prescription opioid use. Pain 2024:00006396-990000000-00617. [PMID: 38833573 DOI: 10.1097/j.pain.0000000000003286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/15/2024] [Indexed: 06/06/2024]
Abstract
ABSTRACT Post-traumatic stress disorder (PTSD) is common in patients with chronic pain, adversely affects chronic pain outcomes, and is associated with opioid use and adverse opioid outcomes. Social support is a robust predictor of PTSD incidence and course as well as chronic pain outcome. We determined whether the association between PTSD and persistent opioid use was modified by emotional support in a cohort of patients receiving opioids for noncancer pain. Eligible participants were ≥18 years and had completed a new period of prescription opioid use lasting 30 to 90 days. Bivariate associations between cohort characteristics and each key variable was assessed using χ2 tests for categorical variables and t-tests for continuous variables. Interaction between PTSD and emotional support was assessed by a priori stratification on low vs high emotional support. Participants (n = 808) were 53.6 (SD ± 11.6) years of age, 69.8% female, 69.6% White, and 26.4% African American. Overall, 17.2% had probable PTSD. High emotional support was significantly (P < 0.0001) more common among those without probable PTSD. Prescription opioid use at 6-month follow-up was significantly (P = 0.0368) more common among patients with vs without probable PTSD. In fully adjusted models, PTSD was no longer associated with opioid use at 6-month follow-up among participants with high emotional support. Among those with lower emotional support, PTSD was significantly associated with opioid use at 6-month follow-up in unadjusted (odds ratio = 2.40; 95% confidence interval: 1.24-4.64) and adjusted models (odds ratio = 2.39; 95% confidence interval: 1.14-4.99). Results point to the hypothesis that improvement of emotional support in vulnerable patients with chronic pain and PTSD may help reduce sustained opioid use.
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Affiliation(s)
- Mark D Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, United States
| | - Lauren Wilson
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Matthew Amick
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, United States
| | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Celeste Zabel
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, United States
| | - Patrick J Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health, One Ford Place, Detroit, MI, United States
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, United States
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, United States
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, United States
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Gray JC, Larson MJ, Moresco N, Dufour S, Ritter GA, DeLeon PD, Milliken CS, Vest N, Adams RS. Healthcare utilization and readiness outcomes among soldiers with post-deployment at-risk drinking, by multimorbidity class. Alcohol 2024; 114:31-39. [PMID: 37619959 PMCID: PMC10881892 DOI: 10.1016/j.alcohol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Abstract
Although alcohol use disorder (AUD) regularly co-occurs with other conditions, there has not been investigation of specific multimorbidity classes among military members with at-risk alcohol use. We used latent class analysis (LCA) to cluster 138,929 soldiers with post-deployment at-risk drinking based on their co-occurring psychological and physical health conditions and indicators of alcohol severity. We examined the association of these multimorbidity classes with healthcare utilization and military readiness outcomes. Latent class analysis was conducted on 31 dichotomous indicators capturing alcohol use severity, mental health screens, psychological and physical health diagnoses, and tobacco use. Longitudinal survival analysis was used to examine the relative hazards of class membership regarding healthcare utilization (e.g., emergency department visit, inpatient stay) and readiness outcomes (e.g., early separation for misconduct). Latent class analysis identified five classes: Class 1 -Relatively Healthy (51.6 %); Class 2 - Pain/Tobacco (17.3 %); Class 3 - Heavy Drinking/Pain/Tobacco (13.1 %); Class 4 - Mental Health/Pain/Tobacco (12.7 %); and Class 5 - Heavy Drinking/Mental Health/Pain/Tobacco (5.4 %). Musculoskeletal pain and tobacco use were prevalent in all classes, though highest in Classes 2, 4, and 5. Classes 4 and 5 had the highest hazards of all outcomes. Class 5 generally exhibited slightly higher hazards of all outcomes than Class 4, demonstrating the exacerbation of risk among those with heavy drinking/AUD in combination with mental health conditions and other multimorbidity. This study provides new information about the most common multimorbidity presentations of at-risk drinkers in the military so that targeted, individualized care may be employed. Future research is needed to determine whether tailored prevention and treatment approaches for soldiers in different multimorbidity classes is associated with improved outcomes.
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Affiliation(s)
- Joshua C Gray
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, Bethesda, MD 20814, United States.
| | - Mary Jo Larson
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States
| | - Natalie Moresco
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States
| | - Steven Dufour
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, Bethesda, MD 20814, United States; Naval Medical Center Portsmouth, Portsmouth, VA 23708, United States
| | - Grant A Ritter
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States
| | - Patrick D DeLeon
- Walter Reed National Military Medical Center, Bethesda, MD 20814, United States
| | - Charles S Milliken
- Army's Substance Use Disorder Clinical Care, Office of the Army Surgeon General, Defense Health Headquarters, 7700 Arlington Blvd., Falls Church, VA 22042, United States
| | - Noel Vest
- Boston University School of Public Health, Department of Community Health Sciences, Boston, MA 02118, United States
| | - Rachel Sayko Adams
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States; Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, MA 02118, United States; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO 80045, United States
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Hammett PJ, Eliacin J, Makris UE, Allen KD, Kerns RD, Heapy A, Goldsmith ES, Meis LA, Taylor BC, Saenger M, Cross LJS, Do T, Branson M, Burgess DJ. An Analysis of the Role of Mental Health in a Randomized Trial of a Walking Intervention for Black Veterans With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:55-67. [PMID: 36162790 DOI: 10.1016/j.jpain.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/03/2022] [Accepted: 07/15/2022] [Indexed: 02/08/2023]
Abstract
Black patients and those with co-occurring mental health disorders are disproportionately affected by chronic pain, but few interventions target these populations. This is a secondary analysis of a randomized trial of a walking-focused proactive counseling intervention for Black Veterans with chronic musculoskeletal pain (ACTION). The primary aim was to examine intervention effectiveness among Veterans with an electronic health record-documented mental health diagnosis [depressive disorder, anxiety disorder, substance use disorder, post-traumatic stress disorder or serious mental illness (n = 205)] and those without a diagnosis (n = 175). About 380 Black Veterans receiving care at the Atlanta VA Health Care System were enrolled from 2016 to 2019 and randomized to the intervention or usual care (UC) (1:1). The intervention featured 6 telephone coaching sessions over 8-14 weeks to encourage walking. Participants with a mental health disorder were more likely to complete all counseling sessions (56% vs 38%) and reported improvements in global perceptions of pain and pain intensity/interference (secondary outcomes) at 3-months vs UC. Among participants without a mental health disorder, the intervention was associated with an improvement in pain-related disability at 6-months (primary outcome). Black chronic pain patients with co-occurring mental health disorders may require more intensive treatment to affect improvement in pain-related disability. PERSPECTIVE: This study examines the effectiveness of a walking intervention for chronic pain among Black Veterans with a mental health disorder. These patients were more engaged with the intervention than those without a mental health disorder. However, they did not experience reductions in pain-related disability, suggesting more intensive treatment is needed.
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Affiliation(s)
- Patrick J Hammett
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Johanne Eliacin
- Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana; Health Services Research, Regenstrief Institute, Indianapolis, Indiana
| | - Una E Makris
- Department of Internal Medicine, UT Southwestern (UTSW) Medical Center, Dallas, Texas; Department of Population and Data Sciences, UTSW, Dallas, Texas; Department of Medicine, VA North Texas Health Care System, Dallas, Texas; Department of Internal Medicine, Division of Rheumatic Diseases, VA North Texas Health Care System, Dallas, Texas
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Durham, North Carolina; Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert D Kerns
- Departments of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center of Innovation, VA Connecticut Health Care System, West Haven, Connecticut
| | - Alicia Heapy
- Departments of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center of Innovation, VA Connecticut Health Care System, West Haven, Connecticut
| | - Elizabeth S Goldsmith
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Laura A Meis
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Brent C Taylor
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Michael Saenger
- Atlanta Veterans Affairs Health Care System, Atlanta, Georgia; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lee J S Cross
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Tam Do
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Mariah Branson
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Green BN, Dunn AS. An Essential Guide to Chiropractic in the United States Military Health System and Veterans Health Administration. JOURNAL OF CHIROPRACTIC HUMANITIES 2021; 28:35-48. [PMID: 35002576 PMCID: PMC8720651 DOI: 10.1016/j.echu.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this article is to provide an essential overview of chiropractic services in United States military and veterans' health care systems. METHODS We reviewed literature, legislation, and policies from 1936 through September 2021 pertaining to chiropractic services in the United States military and veterans' health systems. Using these sources and our combined experience in these systems, we identified fundamental themes in the delivery of chiropractic care in the health care systems of the Department of Defense (providing health care for active duty service members) and the Department of Veterans Affairs (providing health care for veterans) in main topic areas. RESULTS We identified 7 main topic areas relevant to the 2 systems: populations served by chiropractors; health care systems; integration; utilization and supply of chiropractic care; vetting of chiropractors; roles and evaluation of chiropractors; and oversight and leadership. Key information about chiropractic care in these systems was synthesized into the main topic areas. Benefits of high-quality within-system chiropractic care to active-duty service members and veterans are presented. The assets that within-system chiropractors bring to the Department of Defense and Department of Veterans Affairs health care systems are discussed for each main topic area. CONCLUSION This article contains an essential overview of chiropractic services in the Department of Defense and the Department of Veterans Affairs. It offers clarity regarding the integration of chiropractic services into these health care systems and includes a 1-page brief of talking points that may help better inform ongoing discussions of chiropractic services in these 2 different but intertwined environments.
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Affiliation(s)
- Bart N. Green
- National University of Health Sciences, Lombard, Illinois
| | - Andrew S. Dunn
- Chiropractic Department, VA Western New York Healthcare System, Buffalo, New York
- Department of Chiropractic Clinical Sciences, New York Chiropractic College, Seneca Falls, New York
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