Background & Aims
We have established the first national Australian holistic service for veterans, the National Centre of Veterans’ Healthcare (NCVH) at the Concord Repatriation General Hospital. This is the first multidisciplinary service for Australian veterans including pain management. Chronic pain is found to be a significant health issue amongst Australian veterans.
This study assesses:
– The quality of presenting veterans’ pain experience
-The psychological impact of chronic pain on those veterans presenting to NCVH
-The comparative difference in psychological impact of chronic pain with age and sex matched cohort of non-veteran patients attending the Concord Hospital Pain Clinic
This study establishes the specific needs of the Australian veteran in order to direct future service goals.
Methods
This is a retrospective study. Patients presenting to the NCVH are age and sex matched to patients attending the Concord Hospital Pain Clinic. The first cohort of NCVH patients with chronic pain who have completed a psychometric questionaire are analysed and then matched to Pain Clinic patients attending within the same time period.
Primary endpoints are:
1.pain intensity
2.pain activity interference
3.psychological impact of pain- depression, anxiety, stress scores, pain self-efficacy, pain catastrophizing
Secondary endpoints are:
1.medication use
2.prevalence of PTSD diagnosis amongst veterans and non-veterans presenting to NCVH and Pain Clinic at the Concord Repatriation General Hospital
3.prevalence of previous active deployment to war zones amongst those presenting to NCVH with chronic pain
4. Use of recreational drugs for pain
Results
It was not possible to completely match NCVH patients to the Pain Clinic cohort. Veterans are mostly males and younger whereas those presenting to the Pain Clinic are mostly females and older as is typical of those presenting to a community pain center. The first 81 NCVH patients were matched only to 61 community pain patients. There is a significant prevalence of PTSD amongst NCVH patients; 55 NCVH patients were diagnosed with PTSD at presentation versus only 6 patients in the community pain group. Those with PTSD diagnosis, whether in the NCVH or community, have higher scores in anxiety, depression and stress even when their pain intensities are not significantly affected. Warzone deployment did not appear to impact on prevalence as there is significant PTSD diagnosis in non-deployed veterans due to trauma unrelated to deployment.
Conclusions
This is the first qualitative study of chronic pain presentation in Australian veterans. PTSD is highly prevalent amongst Australian chronic pain veterans, more than those in community chronic pain patients. PTSD significantly impacts upon chronic pain experience in all patients. However, the chronic pain veteran is more affected due to their younger age, hence disability has a potential higher social impact. PTSD needs to be addressed as a priority in pain management especially for the Australian veteran. Medication and recreational drug use for pain will be further analysed.
References
(1)Australian Gulf War Veterans’ Followup Health Study Summary Report 2015 Monash University.
(2)Veterans and chronic pain. Gauntlett-Gilbert J and Wilson S. British Journal of Pain. 2013; 7(2), 79-84
(3)Complexity of the relationship of pain, posttraumatic stress, and depression in combat-injured populations: an integrative review to inform evidence-based practice. Worldviews on Evidence-based Nursing, 2018; 15:2, 113-126.
(4) Depression and chronic pain. Holmes A, Christekis N, Arnold C. MJA Open 2012; 1 Suppl 4: 17-20.
(5)Associations between pain appraisals and pain outcomes: meta-analyses of laboratory pain and chronic pain literatures. Jackson T, Wang Y, Tan H. Journal of Pain. 2014; 15(6): 586-601.
(6) Quantitative testing of pain perception in subjects with PTSD – Implications for the mechanism of the coexistence between PTSD and chronic pain. Defrin R, Ginzburg K, Solomon Z et al. Pain 2008; 138: 450-459.
Presenting Author
Winnie Hong
Poster Authors
Topics
- Assessment and Diagnosis