Health care utilization among veterans with pain and posttraumatic stress symptoms

Samantha D. Outcalt, Zhangsheng Yu, Helena Maria Hoen, Tenesha Marie Pennington, Erin E. Krebs

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Objective: To examine health care utilization among veterans with both chronic pain and posttraumatic stress symptoms. Methods: Retrospective cohort study of 40,716 veterans in a VA regional network from January 1, 2002 to January 1, 2007. Veterans were categorized into pain-only, posttraumatic stress disorder symptoms (PTSD)-only, and pain plus PTSD (pain+PTSD) comparison groups. Negative binomial models were used to compare adjusted rates of primary care, mental health, and specialty pain service use, as well as opioids, benzodiazepines, nonopioid analgesics, and antidepressant prescriptions. Rates of clinic visits were calculated by days per year, and rates of medication use were calculated by prescription months per year. Participants were followed for a mean duration of 47 months. Results: Participants were 94.7% men and had a mean age of 58.9 years. Nearly all used primary care (99.2%), 37.1% used pain-related specialty care, and 33.8% used mental health services. Nonopioid and opioid analgesics were the most commonly used medications (63.7% and 53.8%, respectively). Except for mental health visits, which did not differ between PTSD-only and pain+PTSD groups, the pain+PTSD group used significantly more of all categories of health care services than the pain-only and PTSD-only groups. For example, the pain+PTSD group had 7% more primary care visits (rate ratio [RR]=1.07; 95% confidence interval [CI]: 1.05, 1.09) than the pain-only group and 46% more primary care visits than the PTSD-only group (RR=1.46; 95% CI: 1.40, 1.52). Adjusted rates of opioid, benzodiazepine, nonopioid analgesic, and antidepressant prescriptions were higher for the pain+PTSD group than either of the comparison groups. Conclusions: Our findings support our expectation that veterans with both pain and PTSD symptoms use more health care services than those with pain or PTSD symptoms alone. Research is needed to assess the health care costs associated with increases in health care utilization among these veterans.

Original languageEnglish (US)
Pages (from-to)1872-1879
Number of pages8
JournalPain Medicine (United States)
Issue number11
StatePublished - Nov 1 2014

Bibliographical note

Publisher Copyright:
© 2014 American Academy of Pain Medicine 15 11 November 2014 10.1111/pme.12045 PRIMARY CARE & HEALTH SERVICES SECTION Original Research Articles Original Research Article Wiley Periodicals, Inc.


  • Chronic Pain
  • Health Care
  • Posttraumatic Stress Syndrome


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