Deployment-Related Traumatic Brain Injury and Risk of New Episodes of Care for Back Pain in Veterans

Abstract

Traumatic brain injury (TBI) may be a predisposing factor to pain syndromes other than headache. We conducted a longitudinal cohort study among veterans evaluated for TBI in the US Department of Veterans Affairs (VA). Among 36,880 veterans at baseline, 55% reported back pain. TBI history was classified by trained clinicians according to VA-US Department of Defense criteria. 14,223 Veterans without back pain were followed for up to 6 years for new (incident) episodes of VA care for back pain. We estimated adjusted odds ratios (aORs), adjusted hazard ratios (aHRs), and 95% confidence intervals (CI), accounting for covariates. Deployment-related mild TBI was significantly associated with self-reported back pain in cross-sectional analyses (aOR = 1.27, 95% CI = 1.21–1.35), but not with incident episodes of VA care for back pain in longitudinal analysis (aHR = 1.07, 95% CI = 0.99–1.17). Deployment-related moderate to severe TBI was significantly associated with self-reported back pain in cross-sectional (aOR = 1.74, 95% CI = 1.58–1.91), and longitudinal analyses (aHR = 1.20, 95% CI = 1.05–1.38; P = .01). These findings indicate that deployment-related moderate to severe TBI confers increased back pain risk, but do not support a causal effect of deployment-related mild TBI on back pain. PerspectiveFindings from this longitudinal study of veterans indicate that deployment-related moderate to severe TBI confers increased back pain risk, but do not support a causal effect of deployment-related mild TBI on back pain.