(PS6-D85) Associations Among Chronic Pain and Social Well-being Indicators in Veterans with Comorbid Chronic Pain and Posttraumatic Stress Disorder

Background: Chronic musculoskeletal pain and posttraumatic stress disorder (PTSD) are prevalent and costly public health concerns in veteran populations. Social well-being indicators such as social functioning (SF) and perceived burdensomeness (PB) are linked to morbidity, mortality, and suicidality. There is a dearth of research on the relationship between chronic musculoskeletal pain and social well-being indicators in veterans with comorbid PTSD, and this study aimed to fill the gaps by examining relations among chronic pain, SF, and PB in veterans.

Methods: This analysis examined data from a randomized controlled trial (RCT) of an interdisciplinary functional restoration program for chronic pain called Functional and Orthopedic Rehabilitation Treatment-Amended (FORT-A) compared to treatment as usual (TAU) in a VA setting. Measures included the Oswestry Disability Index (ODI), the West Haven-Yale Multidimensional Pain Inventory (MPI), the PB subscale of the Interpersonal Needs Questionnaire (INQ-15), and an SF proxy measure constructed from six MPI questions to examine chronic pain, SF, and PB relations. Cross-sectional and longitudinal analyses, including mixed models, were controlled for race/ethnicity, gender, age, marital/cohabitating status, and service-connected disability throughout, and baseline pain and PTSD scores as needed.

Results: Participants were predominantly male (78.6%), Caucasian (62%), non-Hispanic (58%), married/living with a partner (74.8%), Army affiliated (64%), and retired (51.5%) or veterans (45.6%). The mean age was 43.7 (±10.2). Adjusted models examining relations between Black/African American race and age, respectively, with PB were not statistically significant. Results of unadjusted models examining women and men on SF and PB at baseline were mixed; SF was not statistically different between women and men, but women reported lower PB compared to men (X²(1,N=103)=5.44, p=.02). Adjusted mixed models examining longitudinal outcomes of SF predicted by baseline PB and outcomes of SF and PB predicted by treatment group were not statistically significant. Post-hoc analyses indicated participants with low SF and high PB at baseline in TAU retained low SF and high PB in greater percentages at post-treatment compared to FORT-A participants. A statistically significant difference on low SF/high PB retention percentages was found for PB (X²(1, N=87)=2.53, p=.04) but not for SF.

Conclusion: The statistical findings indicated SF and PB did not have cross-sectional relations with chronic pain, and treatment group did not impact longitudinal SF or PB outcomes in veterans treated for pain and PTSD. The inclusion of numerous covariates and low post-hoc power limits our interpretation. Nonetheless, the findings indicate SF and PB are deserving of more research, particularly in veterans experiencing polymorbid chronic pain.

Funding: This study was funded under an award from the National Center for Complementary and Integrative Health (Award R01 AT008422-01; PI: D. McGeary).

Disclaimer: Opinions, interpretations, conclusions, and recommendations are solely those of the authors and do not reflect an endorsement by or the policy or position of USU, the DoD, the VA, NIH, or the U.S. Government.