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Exploring the Role of Insomnia in the Relation Between PTSD and Pain in Veterans With Polytrauma Injuries

Lang, Katie P. MS; Veazey-Morris, Katherine PhD; Andrasik, Frank PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: January/February 2014 - Volume 29 - Issue 1 - p 44–53
doi: 10.1097/HTR.0b013e31829c85d0
Original Articles

Background: Soldiers returning from Operation Enduring Freedom/Operation Iraqi Freedom experience polytrauma injuries including traumatic brain injury. Traumatic brain injury is often complicated by symptoms of insomnia, posttraumatic stress disorder (PTSD), and pain that can impact treatment and rehabilitation.

Methods: The medical records of 137 veterans seen at a Veterans Affairs Medical Center Polytrauma clinic who sustained traumatic brain injury in combat were reviewed for this study. Demographic variables include age, sex, ethnicity, military branch, and service connection. Outcome measures include PTSD, pain, and insomnia.

Results: Analyses revealed a high prevalence of PTSD, insomnia, and pain co-occurring in 51.8% of veterans. Increased PTSD symptomatology was significantly correlated with reports of more pain severity (r = 0.53), pain interference (r = 0.61), and insomnia (r = 0.67). Further analyses, controlling for service connection, indicated that insomnia partially mediated the relation between PTSD and both pain severity and interference.

Conclusions: These results highlight the overlap and complexity of presenting complaints in veterans and help identify the role of sleep disturbances in complicating diagnosis and treatment of veterans. As sleep problems reduce pain tolerance and exacerbate other symptoms, such as cognitive deficits and irritability, failure to address sleep disturbances may compromise rehabilitation efforts, suggesting the importance of a multidisciplinary team approach to assessing and treating these veterans.

Department of Psychology, The University of Memphis (Ms Lang and Drs Veazey-Morris and Andrasik), and Memphis VA Medical Center, Memphis, Tennessee (Dr Veazey-Morris).

Corresponding Author: Katie P. Lang, MS, Department of Psychology, The University of Memphis, 202 Psychology Bldg, Memphis, TN 38152 (

This work was supported by the Memphis VA Medical Center Office of Research and Development.

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins