(638) Chronic Pain in Veterans with Substance Abuse and Posttraumatic Stress Disorder: A Hidden Diagnosis

Authors: Satyanalrayana Chandragiri, Temple University Hospital; Betty Jo Vael, VA Medical Center; Steven King, Temple University Hospital; Thomas Hardy, Temple University Hospital There is a paucity of systematic studies of chronic pain in the group of patients with substance abuse and post traumatic stress disorder (PTSD). This lack of systematic studies is reflected in the controversies regarding management of chronic pain in populations with substance abuse and PTSD. In this study we evaluated the relationship of chronic pain to PTSD and substance abuse in patients undergoing treatment for substance abuse in a Veterans Affair Medical Center. In this two‐staged study design, 164 veterans were screened for chronic pain. Among those screened, 68% had chronic pain with a mean duration of 14.9 years (N=113 range 1to 38 years, SD 10.6). Those patients who agreed to participate underwent the second stage of the study where standardized measures of pain, substance abuse and PTSD were completed. The measures included McGill pain questionnaire, Addiction Severity Index and Penn inventory respectively. The mean score on the Penn inventory was 37.6 in the group with pain and 24.1 in those without pain. The difference in mean score of the Total Penn inventory was significant ( t =13.34 df 35, P <0.001). The group with chronic pain had higher number of veterans using alcohol (chi‐square 4.64 df 1 P =0.31). Those without chronic pain had different patterns of drug abuse when compared to those who had pain. Patients with substance abuse, PTSD and chronic pain appear to have more severe PTSD symptoms. The differential pattern of substance use suggests patients may be self‐medicating their pain. The high prevalence of chronic pain in this population calls for special sensitivity for pain in those who treat substance use and PTSD.