PTSD and Pain Management: VA’s Latest Research

by Robert Kerns

As a leader in health research, VA prides itself on delivering care to Veterans that is supported by scientific evidence and input from experts.  We specifically bring together clinicians, policy makers, educators and scientists to address the health care needs of the Veterans we are proud to serve.

After a decade of war, researching and finding ways to effectively treat post-traumatic stress disorder (PTSD) is one of VA’s most important tasks.  For example, VA has led the way in developing effective treatments for PTSD including two important non-drug approaches, like Cognitive Processing Therapy and Prolonged Exposure. These therapies may be offered as part of a comprehensive plan for helping Veterans address their symptoms of PTSD, with or without the use of medications.

A record number of Iraq and Afghanistan Veterans have survived their war injuries and now face pain and mental health problems, particularly PTSD.  Consistent with these observations, VA is working to develop clinical programs that can effectively help Veterans with both of these issues in an integrated manner.  As just one example, VA researchers are currently evaluating the effectiveness of an integrated behavioral treatment for Veterans with chronic pain and PTSD.  Responding to feedback from Veterans, this approach is a particularly brief treatment that involves only six outpatient treatment sessions over a three week period.  Early findings from this research encourage optimism that this therapy can lead to meaningful improvements in both pain and symptoms of PTSD for Veterans.

Consistent with this effort, on March 7, the Journal of the American Medical Association published a VA study called, “Association of Mental Health Disorders with Prescription Opioids and High-Risk Opioid Use in Veterans of Iraq and Afghanistan.”  In plain terms, this study investigated the impact of mental health disorders, particularly PTSD, on risks and harm associated with the use of prescription pain medications (called opioids) for the management of chronic pain.  The study authors concluded that among U.S. Veterans of Iraq and Afghanistan, those with mental health diagnoses, especially PTSD, were more likely to be prescribed opioid medications for pain management, and that Veterans with chronic pain and PTSD in particular, who were treated with opioids, experienced negative life events in the course of their care.

Unfortunately, little is known about the association of mental health disorders and prescription opioid use.  Although no one would argue that pain medications have no role in managing pain in Veterans with mental health disorders, VA recognizes the growing concerns about the potential for overreliance on these medications and possible negative effects of opioid therapy especially among Veterans with PTSD.   It remains unclear how to best treat these problems simultaneously, and in particular, how to use pain medications safely.  To address these concerns, VA continues to conduct research such as the study described above.

At VA, we know PTSD is a complex condition that can’t be treated solely by drugs.  We’re also aware that some Veterans are sensitive to the perception that VA may over-prescribe medications in some cases.  This is one reason why VA is working aggressively to ensure that all Veterans with PTSD who are interested are offered one of the behavioral therapies that have been proven to be effective.  At the same time, continued research to better understand the role of opioid and other medications in the management of chronic pain and PTSD is particularly important.

Serving Veterans is our #1 priority, and we’re glad to be working with those Veterans in our community to come together to find the best solutions to meet these issues head-on.

Dr. Robert D. Kerns is the National Program Director for Pain Management for the Department of Veterans Affairs.