• Karen H Seal, Daniel Bertenthal, Deborah E Barnes, Amy L Byers, Carolyn J Gibson, Tessa L Rife, Kristine Yaffe, and Chronic Effects of Neurotrauma Consortium Study Group.
• San Francisco Veterans Affairs Health Care System, San Francisco, California; University of California, San Francisco, San Francisco, California. Electronic address: Karen.Seal@va.gov.
• J Pain. 2018 Aug 1; 19 (8): 931-941.

AbstractClinical practice guidelines admonish against prescribing opioids for individuals with chronic pain and traumatic brain injury (TBI) because of increased risk for adverse outcomes, yet no studies have described opioid prescribing patterns in these higher-risk patients. Between October 2007 and March 2015, 53,124 Iraq and Afghanistan veterans with chronic pain not prescribed opioids in the previous year were followed for 1 year after completing a Comprehensive TBI Evaluation within the Department of Veterans Affairs health care facilities. Veterans reporting the most severe TBI sequelae (eg, loss of consciousness >30 minutes) were significantly more likely to receive short-term and long-term opioid therapy than those with less severe or no TBI sequelae (P values < .001). In analyses adjusted for sociodemographic characteristics, military service, pain disability, and previous nonopioid treatment modalities, veterans with moderate to severe TBI had a significantly increased risk of receiving opioid therapy. Veterans with moderate to severe TBI and comorbid post-traumatic stress disorder and depression had an even greater risk of initiating long-term opioid therapy in the year after the Comprehensive TBI Evaluation (adjusted relative risk = 3.57 [95% confidence interval = 2.85-4.47]). Higher-risk patients with chronic pain and TBI with mental health comorbidities may benefit from improved access to behavioral health and nonpharmacological therapies for chronic pain.Copyright © 2018. Published by Elsevier Inc.

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