{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T06:09:11Z","timestamp":1778652551845,"version":"3.51.4"},"reference-count":40,"publisher":"Oxford University Press (OUP)","funder":[{"name":"Wounded Warrior Project"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pain is highly comorbid with mental health issues in Veterans and service members. This study examined the feasibility and preliminary outcomes of augmenting a 2-week intensive outpatient (IOP) mental health program for veteran military service members with transcranial direct current stimulation (tDCS) to address comorbid pain,\u00a0 PTSD and depressive symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Thirty-eight participants were enrolled in an open pilot trial of up to 10 tDCS sessions (in-person or home-based at 2 mA for 20 minutes\u00a0over bilateral motor cortex) for chronic pain delivered daily before individual therapy during the 2-week Emory Healthcare Accelerated Brain Health Program (ABHP). For PTSD and depression outcomes only, 38 demographically case-matched controls were compared to those who received tDCS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-seven percent of those enrolled completed at least seven tDCS sessions. During the 2-week treatment period, pain scores as measured by the Defense and Veterans Pain Rating Scale (DVPRS) showed significant reductions in pain interference with activity, sleep, mood, and stress (P\u2019s = .008-.014), though interference increased significantly over 12 months following discontinuation of tDCS (P\u2019s = .004-.011) and returned close to baseline. PTSD and depression severity significantly improved during treatment (PTSD, B\u2009=\u2009\u22121.68, P &amp;lt; .001; depression, B\u2009=\u2009\u22120.58, P &amp;lt; .001) and was maintained over 12 months. No significant differences in mental health symptom trajectories were observed between open trial tDCS and matched controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This pilot study shows that integrating tDCS into an IOP is feasible and is associated with short-term reductions in pain. PTSD and depression symptoms were reduced in both groups; however, the reductions among those receiving tDCS were not significantly different from those observed with psychotherapy alone. Though the impacts of tDCS faded with time, its acute association with reduced pain interference warrants further study in larger controlled trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trials Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov. Identifier: NCT-05254379.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag220","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:48:35Z","timestamp":1777376915000},"source":"Crossref","is-referenced-by-count":0,"title":["Reducing Chronic Pain With Transcranial Direct Current Stimulation in Veterans Engaged in Intensive Outpatient Mental Health Treatment: A Pilot Study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9686-4011","authenticated-orcid":false,"given":"Sheila A M","family":"Rauch","sequence":"first","affiliation":[{"name":"Mental Health Service Line, Joseph Maxwell Cleland Atlanta VA Medical Center , Decatur, GA 30030,","place":["United States"]},{"name":"Center for Visual and Neurocognitive Research, Joseph Maxwell Cleland Atlanta VA Medical Center , Decatur, GA 30030,","place":["United States"]},{"name":"Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine , Atlanta, GA 30329,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9131-7569","authenticated-orcid":false,"given":"Carly","family":"Yasinski","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine , Atlanta, GA 30329,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8176-8964","authenticated-orcid":false,"given":"Mahsa","family":"Mojallal","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine , Atlanta, GA 30329,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0644-6049","authenticated-orcid":false,"given":"Anna","family":"Woodbury","sequence":"additional","affiliation":[{"name":"Center for Visual and Neurocognitive Research, Joseph Maxwell Cleland Atlanta VA Medical Center , Decatur, GA 30030,","place":["United States"]},{"name":"Department of Anesthesiology, Emory University School of Medicine , Atlanta, GA 30322,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Black","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine , Atlanta, GA 30329,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3583-834X","authenticated-orcid":false,"given":"Syreese","family":"Fuller","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine , Atlanta, GA 30329,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5875-492X","authenticated-orcid":false,"given":"Jeffrey H","family":"Boatright","sequence":"additional","affiliation":[{"name":"Center for Visual and Neurocognitive Research, Joseph Maxwell Cleland Atlanta VA Medical Center , Decatur, GA 30030,","place":["United States"]},{"name":"Department of Ophthalmology, Emory University School of Medicine , Atlanta, GA 30322,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Coulter","sequence":"additional","affiliation":[{"name":"Center for Visual and Neurocognitive Research, Joseph Maxwell Cleland Atlanta VA Medical Center , Decatur, GA 30030,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4768-7332","authenticated-orcid":false,"given":"Jessica L","family":"Maples-Keller","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine , Atlanta, GA 30329,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4653-0483","authenticated-orcid":false,"given":"Boadie W","family":"Dunlop","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Health, Medical College of Georgia at Augusta University , Augusta, GA 30901,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0732-1248","authenticated-orcid":false,"given":"Melba A","family":"Hernandez-Tejada","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston , Houston, TX 77054,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2253-7434","authenticated-orcid":false,"given":"Hyochol","family":"Ahn","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Arizona , Tucson, AZ 85721,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"2026051301221708100_usag220-B1","doi-asserted-by":"publisher","first-page":"e58","DOI":"10.2196\/mental.7497","article-title":"The 12-item Self-Report world health organization disability assessment schedule (WHODAS) 2.0 administered via the internet to individuals with anxiety and stress disorders: a psychometric investigation based on data from two clinical trials","volume":"4","author":"Axelsson","year":"2017","journal-title":"JMIR Ment Health"},{"key":"2026051301221708100_usag220-B2","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1080\/09638288.2019.1643416","article-title":"Psychometric properties of 12-item self-administered world health organization disability assessment schedule 2.0 (WHODAS 2.0) among general population and people with non-acute physical causes of disability - systematic review","volume":"43","author":"Saltychev","year":"2021","journal-title":"Disabil Rehabil"},{"key":"2026051301221708100_usag220-B3","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1682\/jrrd.2009.01.0006","article-title":"Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF\/OEF veterans: polytrauma clinical trial","volume":"46","author":"Lew","year":"2009","journal-title":"J Rehabil Res Dev"},{"key":"2026051301221708100_usag220-B4","doi-asserted-by":"publisher","first-page":"104420","DOI":"10.1016\/j.jpain.2023.11.003","article-title":"Seventeen-year national pain prevalence trends among U.S. Military veterans","volume":"25","author":"Taylor","year":"2024","journal-title":"J Pain"},{"key":"2026051301221708100_usag220-B5","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1682\/jrrd.2006.06.0065","article-title":"Veterans seeking treatment for posttraumatic stress disorder: what about comorbid chronic pain?","volume":"44","author":"Shipherd","year":"2007","journal-title":"J Rehabil Res Dev"},{"key":"2026051301221708100_usag220-B6","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1037\/a0020512","article-title":"An examination of the co-morbidity between chronic pain and posttraumatic stress disorder on US veterans","volume":"7","author":"Otis","year":"2010","journal-title":"Psychol Serv"},{"key":"2026051301221708100_usag220-B7","author":"VA\/DOD","year":"2022"},{"key":"2026051301221708100_usag220-B8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7103a1","article-title":"CDC clinical practice guideline for prescribing opioids for pain\u2013United States","volume":"71","author":"Dowell","year":"2022","journal-title":"MMWR Recomm Rep"},{"key":"2026051301221708100_usag220-B9","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1093\/tbm\/ibad079","article-title":"Trends in engagement with cognitive-behavioral therapy for chronic pain conditions after referral","volume":"14","author":"Kozel","year":"2024","journal-title":"Transl Behav Med"},{"key":"2026051301221708100_usag220-B10","author":"Chou","year":"2020"},{"key":"2026051301221708100_usag220-B11","author":"McDonagh","year":"2020"},{"key":"2026051301221708100_usag220-B12","author":"FDA","year":"2025"},{"key":"2026051301221708100_usag220-B13","first-page":"1","article-title":"Opioid use among individuals with posttraumatic stress disorder","volume":"30","author":"Bernardy","year":"2019","journal-title":"PTSD Res Quart"},{"key":"2026051301221708100_usag220-B14","doi-asserted-by":"publisher","first-page":"2479923","DOI":"10.1080\/20008066.2025.2479923","article-title":"The pain of PTSD: integrating persistent or chronic pain within emotional processing theory of posttraumatic stress disorder","volume":"16","author":"Hellman","year":"2025","journal-title":"Eur J Psychotraumatol"},{"key":"2026051301221708100_usag220-B15","doi-asserted-by":"publisher","first-page":"e118","DOI":"10.1093\/milmed\/usy225","article-title":"PTSD as a mediator in the relationship between post-concussive symptoms and pain among OEF\/OIF\/OND veterans","volume":"184","author":"Avallone","year":"2019","journal-title":"Mil Med"},{"key":"2026051301221708100_usag220-B16","doi-asserted-by":"publisher","first-page":"20m13752","DOI":"10.4088\/JCP.20m13752","article-title":"Predictors of response to prolonged exposure, sertraline, and their combination for the treatment of military PTSD","volume":"82","author":"Rauch","year":"2021","journal-title":"J Clin Psychiatry"},{"key":"2026051301221708100_usag220-B17","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1016\/j.jpain.2018.02.012","article-title":"Chronic pain, TBI, and PTSD in military veterans: a link to suicidal ideation and violent impulses?","volume":"19","author":"Blakey","year":"2018","journal-title":"J Pain"},{"key":"2026051301221708100_usag220-B18","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1037\/tra0000065","article-title":"Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic","volume":"8","author":"Kehle-Forbes","year":"2016","journal-title":"Psychol Trauma"},{"key":"2026051301221708100_usag220-B19","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1111\/jabr.12001","article-title":"Health care utilization after interdisciplinary chronic pain treatment: part I. description of utilization of costly health care interventions","volume":"17","author":"McGeary","year":"2012","journal-title":"J Appl Biobehav Res"},{"key":"2026051301221708100_usag220-B20","volume-title":"Veterans Affairs and Department of Defense Clinical Practice Guideline for Management of Post-Traumatic Stress","author":"VA\/DOD","year":"2023"},{"key":"2026051301221708100_usag220-B21","doi-asserted-by":"publisher","first-page":"e2249422","DOI":"10.1001\/jamanetworkopen.2022.49422","article-title":"Massed vs intensive outpatient prolonged exposure for combat-related posttraumatic stress disorder: a randomized clinical trial","volume":"6","author":"Peterson","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026051301221708100_usag220-B22","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.jpsychires.2022.06.029","article-title":"Long-term effectiveness of a prolonged exposure-based intensive outpatient program for veterans with posttraumatic stress disorder","volume":"152","author":"Yasinski","year":"2022","journal-title":"J Psychiatr Res"},{"key":"2026051301221708100_usag220-B23","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1177\/1099800419869845","article-title":"The effect of transcranial direct current stimulation on inflammation in older adults with knee osteoarthritis: a Bayesian residual change analysis","volume":"22","author":"Suchting","year":"2020","journal-title":"Biol Res Nurs"},{"key":"2026051301221708100_usag220-B24","doi-asserted-by":"publisher","first-page":"2676","DOI":"10.1093\/pm\/pnaa268","article-title":"Changes in experimental pain sensitivity from using home-based remotely supervised transcranial direct current stimulation in older adults with knee osteoarthritis","volume":"21","author":"Suchting","year":"2020","journal-title":"Pain Med"},{"key":"2026051301221708100_usag220-B25","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1177\/10998004211012479","article-title":"The relationship between plasma BDNF and pain in older adults with knee osteoarthritis","volume":"23","author":"Sorkpor","year":"2021","journal-title":"Biol Res Nurs"},{"key":"2026051301221708100_usag220-B26","doi-asserted-by":"publisher","first-page":"3316","DOI":"10.1093\/milmed\/usac200","article-title":"Management of chronic pain and PTSD in veterans with tDCS+prolonged exposure: a pilot study","volume":"188","author":"Hernandez-Tejada","year":"2023","journal-title":"Mil Med"},{"key":"2026051301221708100_usag220-B27","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1007\/s00296-013-2943-5","article-title":"Involvement of BDNF in knee osteoarthritis: the relationship with inflammation and clinical parameters","volume":"34","author":"Sim\u00e3o","year":"2014","journal-title":"Rheumatol Int"},{"key":"2026051301221708100_usag220-B28","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1037\/pas0000486","article-title":"The clinician-administered PTSD scale for DSM\u20135 (CAPS-5): development and initial psychometric evaluation in military veterans","volume":"30","author":"Weathers","year":"2018","journal-title":"Psychol Assess"},{"key":"2026051301221708100_usag220-B29","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/1073191116638410","article-title":"Psychometric properties of a structured diagnostic interview for DSM-5 anxiety, mood, and obsessive-compulsive and related disorders","volume":"25","author":"Tolin","year":"2018","journal-title":"Assessment"},{"key":"2026051301221708100_usag220-B30","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1001\/jamapsychiatry.2017.2164","article-title":"The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial","volume":"74","author":"Barlow","year":"2017","journal-title":"JAMA Psychiatry"},{"key":"2026051301221708100_usag220-B31","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.jocn.2019.05.023","article-title":"Home-based self-administered transcranial direct current stimulation in older adults with knee osteoarthritis pain: an open-label study","volume":"66","author":"Ahn","year":"2019","journal-title":"J Clin Neurosci"},{"key":"2026051301221708100_usag220-B32","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3109\/10601333.2015.980944","article-title":"Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): review and recommendations from an expert panel","volume":"32","author":"Fregni","year":"2015","journal-title":"Clin Res Regul Aff"},{"key":"2026051301221708100_usag220-B33","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1111\/j.1526-4637.2012.01516.x","article-title":"Preliminary validation of the defense and veterans pain rating scale (DVPRS) in a military population","volume":"14","author":"Buckenmaier","year":"2013","journal-title":"Pain Med"},{"key":"2026051301221708100_usag220-B34","doi-asserted-by":"publisher","first-page":"2446","DOI":"10.1097\/j.pain.0000000000001952","article-title":"Interpretation of chronic pain clinical trial outcomes: IMMPACT recommended considerations","volume":"161","author":"Smith","year":"2020","journal-title":"Pain"},{"key":"2026051301221708100_usag220-B35","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1037\/pas0000254","article-title":"Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans","volume":"28","author":"Bovin","year":"2016","journal-title":"Psychol Assess"},{"key":"2026051301221708100_usag220-B36","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"2026051301221708100_usag220-B37","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1016\/S0306-4530(02)00108-7","article-title":"Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change","volume":"28","author":"Pruessner","year":"2003","journal-title":"Psychoneuroendocrinology"},{"key":"2026051301221708100_usag220-B38","doi-asserted-by":"publisher","first-page":"93","DOI":"10.3389\/fnbeh.2018.00093","article-title":"At-home transcranial direct current stimulation (tDCS) with telehealth support for symptom control in chronically-Ill patients with multiple symptoms","volume":"12","author":"Riggs","year":"2018","journal-title":"Front Behav Neurosci"},{"key":"2026051301221708100_usag220-B39","doi-asserted-by":"publisher","first-page":"20552076241292677","DOI":"10.1177\/20552076241292677","article-title":"The effectiveness of home-based transcranial direct current stimulation on chronic pain: a systematic review and meta-analysis","volume":"10","author":"Antonioni","year":"2024","journal-title":"Digit Health"},{"key":"2026051301221708100_usag220-B40","doi-asserted-by":"publisher","first-page":"103051","DOI":"10.1016\/j.janxdis.2025.103051","article-title":"Bidirectional associations between PTSD symptoms and pain in daily life among women survivors of sexual assault","volume":"114","author":"Brockdorf","year":"2025","journal-title":"J Anxiety Disord"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag220\/68277004\/usag220.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag220\/68277004\/usag220.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T05:22:24Z","timestamp":1778649744000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag220\/8677072"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":40,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag220","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"article-number":"usag220"}}