{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T06:10:42Z","timestamp":1784268642146,"version":"3.55.0"},"reference-count":103,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>The polytrauma clinical triad (PCT) - comprised of posttraumatic stress disorder (PTSD), chronic pain syndromes (CPS), and traumatic brain injury (TBI) - is a significant problem among US Service Members and Veterans (SMV). Many SMV treated for PCT improve within 5\u202fyears of initial presentation, but a significant fraction show declining health despite extensive care, underscoring the necessity for enhanced management strategies in this population. Since PCT commonly presents as a distressing and debilitating polysymptomatic experience centered around pain, the proposed Functional Recovery Enabling Inter-Disciplinary Evaluation and Management (FREIDEM) model conceptualizes PCT as a complex CPS that emerged and persisted in association with PTSD, TBI, and several other comorbidities. The FREIDEM model integrates several recent clinical advances in conceptualizing and treating complex CPSs and proposes that a complex CPS like PCT represents a state of inadequate or suspended self-healing and recovery due to the cumulative impact of several biopsychosocial impediments (multimorbidity) accrued over a lifetime. The treatment of such complex CPSs is theorized as the advancement of self-recovery with functional interventions, therapeutic mitigation of biopsychosocial impediments to recovery and judicious time-limited use of symptom management including pain management. The FREIDEM model offers a clinical evaluation strategy to identify the biopsychosocial impediments and develop a comprehensive structured treatment plan based on the theoretical model. More research is needed to determine if the FREIDEM model reliably improves outcomes for SMVs with PCT, but it offers a solid framework for treating PCT as a complex chronic pain syndrome and to foster further discussion about new treatment approaches.<\/jats:p>","DOI":"10.3389\/fneur.2026.1752206","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:44:41Z","timestamp":1784267081000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Conceptualizing and treating the polytrauma clinical triad as a complex chronic pain syndrome"],"prefix":"10.3389","volume":"17","author":[{"given":"Ajay","family":"Manhapra","sequence":"first","affiliation":[{"name":"Hampton VA Medical Center","place":["Hampton, VA, United States"]},{"name":"Department of Physical Medicine and Rehabilitation and Psychiatry, Eastern Virginia Medical School","place":["Norfolk, VA, United States"]},{"name":"Department of Psychiatry, Yale School of Medicine","place":["New Haven, CT, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eamonn","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System","place":["Salt Lake City, UT, United States"]},{"name":"Division of Epidemiology, Department of Medicine, Spencer Fox Eccles School of Medicine, University of Utah","place":["Salt Lake City, UT, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cifu","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University (VCU)","place":["Richmond, VA, United States"]},{"name":"Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System","place":["Richmond, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon R.","family":"Miles","sequence":"additional","affiliation":[{"name":"Mental Health and Behavioral Sciences Services, James A. Haley Veterans\u2019 Hospital","place":["Tampa, FL, United States"]},{"name":"Department of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida","place":["Tampa, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Jo","family":"Pugh","sequence":"additional","affiliation":[{"name":"Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System","place":["Salt Lake City, UT, United States"]},{"name":"Division of Epidemiology, Department of Medicine, Spencer Fox Eccles School of Medicine, University of Utah","place":["Salt Lake City, UT, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1097\/MLR.0000000000000059","article-title":"Complex comorbidity clusters in OEF\/OIF veterans: the polytrauma clinical triad and beyond","volume":"52","author":"Pugh","year":"2014","journal-title":"Med Care"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0222674","DOI":"10.1371\/journal.pone.0222674","article-title":"Deployment, suicide, and overdose among comorbidity phenotypes following mild traumatic brain injury: a retrospective cohort study from the chronic effects of neurotrauma consortium","volume":"14","author":"Pugh","year":"2019","journal-title":"PLoS One"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1927","DOI":"10.2147\/JPR.S165077","article-title":"The polytrauma clinical trial in patients with chronic pain after motor vehicle collision","volume":"11","author":"Peixoto","year":"2018","journal-title":"J Pain Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1007\/s10880-011-9239-2","article-title":"Complicating factors associated with mild traumatic brain injury: impact on pain and posttraumatic stress disorder treatment","volume":"18","author":"Otis","year":"2011","journal-title":"J Clin Psychol Med Settings"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"E16","DOI":"10.1097\/HTR.0000000000000227","article-title":"Does co-occurring traumatic brain injury affect VHA outpatient health service utilization and associated costs among veterans with posttraumatic stress disorder? 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