{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:49:33Z","timestamp":1779194973335,"version":"3.51.4"},"reference-count":37,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:00:00Z","timestamp":1689724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"U.S. Department of Veterans Affairs (VA) Office of Rural Health","award":["03857"],"award-info":[{"award-number":["03857"]}]},{"name":"U.S. Department of Veterans Affairs Health Services Research and Development (HSR&amp;D) Service","award":["03857"],"award-info":[{"award-number":["03857"]}]},{"name":"Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Health Services Research","award":["03857"],"award-info":[{"award-number":["03857"]}]},{"name":"Center for Access &amp; Delivery Research and Evaluation, Iowa City VA Health Care System","award":["03857"],"award-info":[{"award-number":["03857"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: Chronic pain can worsen PTSD symptomatology and may increase the risk of the prescription of multiple central nervous system (CNS)-active medications. The objective is to determine the impact of chronic pain on the number of CNS medications, including psychiatric medications, as well as the amount of medication changes. Methods: Veterans Affairs (VA) administrative data were used to identify VA-served Veterans with PTSD (N = 637,428) who had chronic pain (50.3%) and did not have chronic pain (49.7%) in 2020. The outcomes included the number of changes in psychiatric medications and the number of currently prescribed CNS-active mediations during a one-year observation period. Results: The number of changes in psychiatric medications was significantly higher for those with chronic pain (mean (M) = 1.8) versus those without chronic pain (M = 1.6) (Z = 38.4, p &lt; 0.001). The mean number of concurrent CNS-active medications were significantly higher for those with chronic pain (M = 2.7) versus those without chronic pain (M = 2.0) (Z = 179.7, p &lt; 0.001). These differences persisted after adjustment for confounding factors using negative binomial regression. Conclusions: Veterans with comorbid chronic pain and PTSD are at increased risk for a higher number of medication changes and for receiving CNS-active polytherapy.<\/jats:p>","DOI":"10.3390\/jcm12144763","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:54:01Z","timestamp":1689728041000},"page":"4763","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Impact of Comorbid Chronic Pain on Pharmacotherapy for Veterans with Post-Traumatic Stress Disorder"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5201-9625","authenticated-orcid":false,"given":"Alessandra A.","family":"Pratt","sequence":"first","affiliation":[{"name":"Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Hadlandsmyth","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA"},{"name":"VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA"},{"name":"Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle A.","family":"Mengeling","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA"},{"name":"VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0416-1157","authenticated-orcid":false,"given":"Emily B. K.","family":"Thomas","sequence":"additional","affiliation":[{"name":"VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA"},{"name":"Department of Psychological and Brain Sciences, University of Iowa College of Liberal Arts and Sciences, 340 Iowa Ave, Iowa City, IA 52246, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Miell","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonya B.","family":"Norman","sequence":"additional","affiliation":[{"name":"National Center for PTSD, 215 North Main Street, White River Junction, VT 05009, USA"},{"name":"Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian C.","family":"Lund","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA"},{"name":"VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA"},{"name":"Department of Biostatistics, University of Iowa College of Public Health, 145 N Riverside Drive, Iowa City, IA 52242, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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 triad","volume":"46","author":"Lew","year":"2009","journal-title":"J. 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