Highlights
- •Veterans with the most severe head injury sequelae were most likely to receive opioid therapy.
- •Veterans with moderate to severe traumatic brain injury were more likely to be prescribed opioids.
- •Veterans with traumatic brain injury and mental health comorbidity were at highest risk for opioids.
Abstract
Clinical practice guidelines admonish against prescribing opioids for individuals
with chronic pain and traumatic brain injury (TBI) because of increased risk for adverse
outcomes, yet no studies have described opioid prescribing patterns in these higher-risk
patients. Between October 2007 and March 2015, 53,124 Iraq and Afghanistan veterans
with chronic pain not prescribed opioids in the previous year were followed for 1
year after completing a Comprehensive TBI Evaluation within the Department of Veterans
Affairs health care facilities. Veterans reporting the most severe TBI sequelae (eg,
loss of consciousness >30 minutes) were significantly more likely to receive short-term
and long-term opioid therapy than those with less severe or no TBI sequelae (P values < .001). In analyses adjusted for sociodemographic characteristics, military
service, pain disability, and previous nonopioid treatment modalities, veterans with
moderate to severe TBI had a significantly increased risk of receiving opioid therapy.
Veterans with moderate to severe TBI and comorbid post-traumatic stress disorder and
depression had an even greater risk of initiating long-term opioid therapy in the
year after the Comprehensive TBI Evaluation (adjusted relative risk = 3.57 [95% confidence
interval = 2.85–4.47]). Higher-risk patients with chronic pain and TBI with mental
health comorbidities may benefit from improved access to behavioral health and nonpharmacological
therapies for chronic pain.
Perspective
Paradoxically, veterans with greater TBI severity and comorbid mental health burden
are more likely to be prescribed opioids for chronic pain. More vulnerable veterans
may benefit from improved access to behavioral health and nonpharmacological modalities
for chronic pain, because of the health and safety risks of opioids.
Key words
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Article info
Publication history
Published online: March 26, 2018
Accepted:
March 14,
2018
Received in revised form:
February 26,
2018
Received:
October 24,
2017
Footnotes
This work was supported by the U.S. Army Medical Research and Materiel Command and the U.S. Department of Veterans Affairs Chronic Effects of Neurotrauma Consortium under award number W81XWH-13-2-0095.
The U.S. Army Medical Research Acquisition Activity (820 Chandler Street, Fort Detrick, MD 21702-5014) is the awarding and administering acquisition office. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the U.S. Government, or the U.S. Department of Veterans Affairs, and no official endorsement should be inferred.
The authors have no conflicts of interest to declare.
Identification
Copyright
© Published by Elsevier Inc. on behalf of the American Pain Society
