Perspectives Among Veterans with Chronic Pain and Co-Occurring Mild Traumatic Brain Injury: Mixed-Method Findings
Amy M Kemp1,2, Kelly Krese3,4, Bella Etingen5,6
1Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA.
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Chronic pain is the leading cause of disability worldwide and frequently co-occurs with mild traumatic brain injury among Veterans (mTBI + CP), creating complex treatment challenges and a need for novel, non-pharmacological interventions. This study evaluated a pilot intervention combining intermittent theta burst stimulation (iTBS), a neuromodulatory approach, with the evidence-based LoveYourBrain Yoga program to enhance rehabilitation outcomes. In a six-week open-label trial, ten Veterans with mTBI + CP received weekly iTBS followed by yoga sessions. Pilot quantitative outcomes included quality of life (Traumatic Brain Injury Quality of Life [TBI-QoL]) and functional ability (Mayo Portland Adaptability Inventory-4 [MPAI-4]), assessed pre- and post-intervention, alongside qualitative semi-structured interviews and interdisciplinary clinical notes. Significant improvements were observed in TBI-QoL Fatigue (p = 0.021) and MPAI-4 Grief and Loss (p = 0.016), with clinically meaningful but non-significant gains in Ability and Adjustment. Qualitative findings revealed improved pain management and enhanced self-management, with participants describing better emotional regulation, more effective coping strategies, and stronger social connections. Some benefits were more evident in qualitative data than in standardized measures. These pilot findings suggest that combining iTBS with mind-body therapy may provide complementary tools for pain management and functional recovery in Veterans with mTBI + CP, supporting further investigation of integrated neuromodulation and behavioral interventions.
