• Andrew J Cook, Eric C Meyer, Lianna D Evans, Kevin E Vowles, John W Klocek, Nathan A Kimbrel, Suzy Bird Gulliver, and Sandra B Morissette.
• Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA; Texas A&M Health Science Center, College of Medicine, Temple, TX, USA.
• Behav Res Ther. 2015 Oct 1; 73: 25-32.

AbstractWar veterans are at increased risk for chronic pain and co-occurring neurobehavioral problems, including posttraumatic stress disorder (PTSD), depression, alcohol-related problems, and mild traumatic brain injury (mTBI). Each condition is associated with disability, particularly when co-occurring. Pain acceptance is a strong predictor of lower levels of disability in chronic pain. This study examined whether acceptance of pain predicted current and future disability beyond the effects of these co-occurring conditions in war veterans. Eighty trauma-exposed veterans with chronic pain completed a PTSD diagnostic interview, clinician-administered mTBI screening, and self-report measures of disability, pain acceptance, depression, and alcohol use. Hierarchical regression models showed pain acceptance to be incrementally associated with disability after accounting for symptoms of PTSD, depression, alcohol-related problems, and mTBI (total adjusted R(2) = .57, p < .001, ΔR(2) = .03, p = .02). At 1-year follow-up, the total variance in disability accounted for by the model decreased (total adjusted R(2) = .29, p < .001), whereas the unique contribution of pain acceptance increased (ΔR(2) = .07, p = .008). Pain acceptance remained significantly associated with 1-year disability when pain severity was included in the model. Future research should evaluate treatments that address chronic pain acceptance and co-occurring conditions to promote functional recovery in the context of polytrauma in war veterans.Published by Elsevier Ltd.

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