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J Pain. 2019 Jan;20(1):97-107. doi: 10.1016/j.jpain.2018.08.002. Epub 2018 Aug 30.

Deployment-Related Traumatic Brain Injury and Risk of New Episodes of Care for Back Pain in Veterans.

Author information

1
Seattle Epidemiologic Research and Information Center (ERIC), Department of Veterans Affairs Office of Research and Development, Seattle; Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle; Department of Rehabilitation Medicine, University of Washington, Seattle. Electronic address: pradeepsuri1@gmail.com.
2
Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston.
3
Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle; Department of Rehabilitation Medicine, University of Washington, Seattle.
4
Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston.

Abstract

Traumatic brain injury (TBI) may be a predisposing factor to pain syndromes other than headache. We conducted a longitudinal cohort study among veterans evaluated for TBI in the US Department of Veterans Affairs (VA). Among 36,880 veterans at baseline, 55% reported back pain. TBI history was classified by trained clinicians according to VA-US Department of Defense criteria. 14,223 Veterans without back pain were followed for up to 6 years for new (incident) episodes of VA care for back pain. We estimated adjusted odds ratios (aORs), adjusted hazard ratios (aHRs), and 95% confidence intervals (CI), accounting for covariates. Deployment-related mild TBI was significantly associated with self-reported back pain in cross-sectional analyses (aOR = 1.27, 95% CI = 1.21-1.35), but not with incident episodes of VA care for back pain in longitudinal analysis (aHR = 1.07, 95% CI = 0.99-1.17). Deployment-related moderate to severe TBI was significantly associated with self-reported back pain in cross-sectional (aOR = 1.74, 95% CI = 1.58-1.91), and longitudinal analyses (aHR = 1.20, 95% CI = 1.05-1.38; P = .01). These findings indicate that deployment-related moderate to severe TBI confers increased back pain risk, but do not support a causal effect of deployment-related mild TBI on back pain. PERSPECTIVE: Findings from this longitudinal study of veterans indicate that deployment-related moderate to severe TBI confers increased back pain risk, but do not support a causal effect of deployment-related mild TBI on back pain.

KEYWORDS:

Concussion; low back pain; musculoskeletal disorders; prognostic; traumatic brain injury

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