Comorbid Pain, Posttraumatic Stress Disorder, and Insomnia Disorder Among Post-9/11 Veterans Enrolling in Veteran Affairs Healthcare: A Complex, Common Clinical Presentation

Chronic, non-malignant musculoskeletal pain (CP) and posttraumatic stress disorder (PTSD) frequently co-occur. Insomnia disorder is common among individuals with pain and PTSD and negatively affects physical and mental health. Specifically, insomnia disorder may contribute to the overall complexity, course, and severity of CP/PTSD, leading to a vicious cycle of chronic insomnia and worse symptom severity. We present secondary analyses of cross-sectional self-report data collected using VA eScreening from N = (3,937) post-9/11 Veterans enrolling for VHA healthcare. Our sample had a mean age of 35.5 years old (SD = 9.0), primarily male (82%), and more than half of the sample was non-Latino/Hispanic (69.5%) and White (64.2%). We analyzed measures of insomnia (Insomnia Severity Index; ISI), pain severity and interference (PROMIS), and PTSD symptoms (PTSD Checklist; PCL). ISI, PROMIS, and PCL were all positively correlated (p’s <.05; ES’s >.44). The ISI had an indirect effect on the association between PTSD and both pain severity (indirect effect =.04, SE =.002, 95% CI [.0312,.0389]) and pain interference (indirect effect =.09, SE =.005, 95% CI [.0765, 0952]). Screening and treating insomnia disorder, in the context of co-occurring PTSD and complex pain disorder is clinically important and may help increase overall quality of life in a high-risk and diverse population. Future studies underway by the VA Center of Excellence Sleep Research Consortium and elsewhere examine relationships among and treatments for sleep disorders, chronic pain, and PTSD and include objective measurement of pain sensitivity, pain interference, and sleep disorders (e.g., polysomnography; actigraphy) when feasible.