Chronic Pain, TBI, and PTSD in Military Veterans: A Link to Suicidal Ideation and Violent Impulses?

Journal Article (Journal Article)

UNLABELLED: The polytrauma clinical triad refers to the co-occurrence of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Despite research implicating dyadic relationships between these conditions and adverse outcomes, scant research has examined the polytrauma clinical triad's relation to suicide or violence. The present cross-sectional study was designed to examine whether this complex clinical presentation increases risk of suicidal ideation and violent impulses after accounting for other established risk factors. Veterans who served in the military since September 11, 2001 (N = 667) who reported chronic pain completed an interview and self-report battery. Bivariate analyses showed that suicidal ideation and violent impulses both correlated with PTSD, TBI+PTSD, pain intensity and interference, drug abuse, and major depressive disorder (MDD). Multiple regression analyses showed that: 1) race, chronic pain with PTSD, alcohol abuse, and MDD significantly predicted suicidal ideation, 2) pain interference, chronic pain with TBI, chronic pain with PTSD, chronic pain with TBI+PTSD, drug abuse, and MDD significantly predicted violent impulses, and 3) pain interference was a more critical predictor of suicidal and violent ideation than pain intensity. Implications for risk assessment and treatment are discussed. PERSPECTIVE: This article presents results from a study examining predictors of suicide and violence risk among a sample of post-9/11 U.S. Veterans with chronic pain. Health care professionals should assess for pain interference, TBI, PTSD, depression, and alcohol/drug abuse when conducting risk assessments with this population.

Full Text

Duke Authors

Cited Authors

  • Blakey, SM; Wagner, HR; Naylor, J; Brancu, M; Lane, I; Sallee, M; Kimbrel, NA; VA Mid-Atlantic MIRECC Workgroup, ; Elbogen, EB

Published Date

  • July 2018

Published In

Volume / Issue

  • 19 / 7

Start / End Page

  • 797 - 806

PubMed ID

  • 29526669

Pubmed Central ID

  • PMC6026045

Electronic International Standard Serial Number (EISSN)

  • 1528-8447

Digital Object Identifier (DOI)

  • 10.1016/j.jpain.2018.02.012


  • eng

Conference Location

  • United States