A Cross-sectional Analysis of Clinical Outcomes Following Chiropractic Care in Veterans With and Without Post-traumatic Stress Disorder
SOURCE: Mil Med. 2009 (Jun); 174 (6): 578–583
Andrew S. Dunn; Steven R. Passmore;
Jeanmarie Burke; David Chicoine
VA of Western New York Healthcare System,
3495 Bailey Avenue,
Buffalo, NY 14215, USA.
This study was a cross-sectional analysis of clinical outcomes for 130 veteran patients with neck or low back complaints completing a course of care within the chiropractic clinic at the VA of Western New York in 2006. Multivariate analysis of variance (MANOVA) was utilized, comparing baseline and discharge scores for both the neck and low back regions and for those patients with and without post-traumatic stress disorder (PTSD). Patients with PTSD (n = 21) experienced significantly lower levels of score improvement than those without PTSD (n = 119) on self-reported outcome measures of neck and low back disability. These findings, coupled with the theorized relationships between PTSD and chronic pain, suggest that the success of conservative forms of management for veteran patients with musculoskeletal disorders may be limited by the presence of PTSD. Further research is warranted to examine the potential contributions of PTSD on chiropractic clinical outcomes with this unique patient population.
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A diagnosis of post-traumatic stress disorder (PTSD) can be conveyed when a person has been exposed to a traumatic event that could be perceived as threatening or that actually threatened the physical integrity of the individual or others, and his or her response involved fear, helplessness, or horror.  The person must also persistently re-experience the perception of the trauma and avoid reminders of the event while displaying symptoms of increased arousal (sleeplessness, irritability, outbursts) for at least 1 month, which disrupts their social, occupational, or other levels of functioning. 
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PTSD is reported to be an especially difficult clinical presentation to treat among veteran patients.  The prevalence of PTSD among veteran patients has been estimated to be between 11.5% and 24.5% over a series of studies utilizing interview and survey methods. [3–6] Among Vietnam veterans, the estimated prevalence of PTSD is as high as 30%.