TY - JOUR
AU - A. A. Pratt
AU - J. Van Tiem
AU - B. C. Lund
AU - N. L. Johnson
AU - K. R. S. Steffensmeier
AU - D. D. Ball
AU - E. B. K. Thomas
AU - M. A. Mengeling
AU - S. B. Norman
AU - M. A. Driscoll
AU - L. Garvin
AU - K. J. Hart
AU - K. Hadlandsmyth
A1 - 
AB - INTRODUCTION: The aim is to elucidate approaches to care for comorbid chronic pain and PTSD (CP + PTSD) in the Veterans Administration (VA). These conditions are co-magnifying and highly comorbid but traditionally treated in separate clinical settings. MATERIALS AND METHODS: This multimethod analysis examined care for CP + PTSD via administrative data analyses and qualitative interviews of VA-served veterans. RESULTS: All participants with diagnoses of CP + PTSD in 2021 were identified using VA administrative data (N = 456,544). Visits during the following year (2022) coded for chronic pain, PTSD, or both were analyzed. Qualitative interview participants (N = 22) were recruited, screened, consented, and enrolled in 2023. Administrative findings demonstrated that clinical settings differed where CP and PTSD were treated. For PTSD, 90.7% of visits occurred in the mental health service line, whereas for CP, visits occurred across a range of settings outside mental health (e.g., primary care, rehabilitative services, and surgical services). A small percentage of visits (4.8%) were coded for both CP + PTSD, indicating possible combined care. In qualitative interviews, participants acknowledged that CP and PTSD symptoms may impact one another but noted that the health care they received for these 2 conditions was typically siloed. Participants also identified barriers that would need to be addressed before a fully integrated coordinated care model could be implemented. CONCLUSIONS: Veterans reported interest in coordinated treatment for CP + PTSD; however, the provision of CP + PTSD care provided across different service lines may pose challenges to optimizing care coordination.
AD - Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA 52246, United States.; VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, IA 52246, United States.; Department of Family and Community Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States.; Department of Psychological and Brain Sciences, University of Iowa College of Liberal Arts and Sciences, Iowa City, IA 52242, United States.; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States.; National Center for PTSD, White River Junction, VT 05009, United States.; Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA 92093, United States.; Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT 06516, United States.; Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, United States.; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States.; Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States.
AN - 40215123
BT - Mil Med
C5 - Healthcare Disparities; Opioids & Substance Use; Education & Workforce
DA - Apr 11
DO - 10.1093/milmed/usaf118
DP - NLM
ET - 20250411
JF - Mil Med
LA - eng
N2 - INTRODUCTION: The aim is to elucidate approaches to care for comorbid chronic pain and PTSD (CP + PTSD) in the Veterans Administration (VA). These conditions are co-magnifying and highly comorbid but traditionally treated in separate clinical settings. MATERIALS AND METHODS: This multimethod analysis examined care for CP + PTSD via administrative data analyses and qualitative interviews of VA-served veterans. RESULTS: All participants with diagnoses of CP + PTSD in 2021 were identified using VA administrative data (N = 456,544). Visits during the following year (2022) coded for chronic pain, PTSD, or both were analyzed. Qualitative interview participants (N = 22) were recruited, screened, consented, and enrolled in 2023. Administrative findings demonstrated that clinical settings differed where CP and PTSD were treated. For PTSD, 90.7% of visits occurred in the mental health service line, whereas for CP, visits occurred across a range of settings outside mental health (e.g., primary care, rehabilitative services, and surgical services). A small percentage of visits (4.8%) were coded for both CP + PTSD, indicating possible combined care. In qualitative interviews, participants acknowledged that CP and PTSD symptoms may impact one another but noted that the health care they received for these 2 conditions was typically siloed. Participants also identified barriers that would need to be addressed before a fully integrated coordinated care model could be implemented. CONCLUSIONS: Veterans reported interest in coordinated treatment for CP + PTSD; however, the provision of CP + PTSD care provided across different service lines may pose challenges to optimizing care coordination.
PY - 2025
SN - 0026-4075
ST - Comorbid Chronic Pain and Posttraumatic Stress Disorder Among Veterans: Approaches to Care
T1 - Comorbid Chronic Pain and Posttraumatic Stress Disorder Among Veterans: Approaches to Care
T2 - Mil Med
TI - Comorbid Chronic Pain and Posttraumatic Stress Disorder Among Veterans: Approaches to Care
U1 - Healthcare Disparities; Opioids & Substance Use; Education & Workforce
U3 - 10.1093/milmed/usaf118
VO - 0026-4075
Y1 - 2025
ER -