Reframing the Polytrauma Clinical Triad as a Multifaceted Chronic Pain Disorder: Approaches to Treatment
By
Ajay Manhapra
Eamonn Kennedy
David Cifu
Shannon R. Miles
Mary Jo Pugh
July 17, 2026
Clinical Scorecard: Reframing the Polytrauma Clinical Triad as a Multifaceted Chronic Pain Disorder: Approaches to Treatment
At a Glance
Category Detail
Condition Polytrauma Clinical Triad (PCT) Key Mechanisms Combination of PTSD, chronic pain syndromes, and traumatic brain injury Target Population US Service Members and Veterans Care Setting Veteran Health Administration facilities
Key Highlights
PCT affects an estimated 13% of US military Veterans in VHA facilities. PCT is associated with higher risks of psychiatric and medical destabilization. Current management often requires integration of multiple clinical guidelines. The FREIDEM model proposes a comprehensive approach to treating PCT. Interdisciplinary care is essential for optimal management of PCT. Guideline-Based Recommendations
Diagnosis
Utilize established criteria for PTSD, CPS, and TBI. Management
Implement the FREIDEM model for a structured treatment plan. Monitoring & Follow-up
Assess for treatment refractory symptoms and adjust care accordingly. Risks
Monitor for increased risk of suicide, overdose, and overall mortality. Patient & Prescribing Data
Service Members and Veterans with PCT
Focus on functional recovery and addressing biopsychosocial impediments.
Clinical Best Practices
Adopt an interdisciplinary approach to care. Facilitate whole-person biopsychosocial care within specialized clinics. Coordinate care to minimize fragmentation and improve patient outcomes. Related Resources & Content
