Perspectives Among Veterans with Chronic Pain and Co-Occurring Mild Traumatic Brain Injury: Mixed-Method Findings from a Neuromodulation and Yoga Intervention

Kemp, Amy M.; Krese, Kelly; Etingen, Bella; Cotner, Bridget A.; Walker, Sadie; Kale, Ibuola; Rafferty, Miriam R.; Kletzel, Sandra; Shah, Rachana P.; Bedo, Sabrina; Chaudhuri, Sarmistha; Aaronson, Alexandra L.; Donnelly, Kyla Z.; Bobra, Sonia; Billups, Andrea; Yen, Pei-Shan; Bhaumik, Dulal; Bender Pape, Theresa L.; Herrold, Amy A.

doi:10.3390/ijerph23070872

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Open AccessArticle

Perspectives Among Veterans with Chronic Pain and Co-Occurring Mild Traumatic Brain Injury: Mixed-Method Findings from a Neuromodulation and Yoga Intervention

by

Amy M. Kemp

^1,2,*

,

Kelly Krese

^3,4

,

Bella Etingen

^5,6

,

Bridget A. Cotner

^2,7

,

Sadie Walker

^2,3,

Ibuola Kale

²

,

Miriam R. Rafferty

^3,8,

Sandra Kletzel

²,

Rachana P. Shah

²,

Sabrina Bedo

²,

Sarmistha Chaudhuri

²

,

Alexandra L. Aaronson

^2,9,

Kyla Z. Donnelly

²,

Sonia Bobra

²,

Andrea Billups

²

,

Pei-Shan Yen

⁵,

Dulal Bhaumik

⁵

,

Theresa L. Bender Pape

^3,8

and

Amy A. Herrold

^2,9

¹

Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA

²

Edward Hines Jr. VA Hospital, Hines, IL 60141, USA

³

Shirley Ryan AbilityLab, Chicago, IL 60611, USA

⁴

Midwestern University, Downers Grove, IL 60515, USA

⁵

Research and Development Service, Dallas VA Medical Center, Dallas, TX 75216-7167, USA

⁶

Department of Health Economics, Systems, and Policy, Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX 75390, USA

⁷

Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA

⁸

Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA

⁹

Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA

^*

Author to whom correspondence should be addressed.

Int. J. Environ. Res. Public Health 2026, 23(7), 872; https://doi.org/10.3390/ijerph23070872

Submission received: 9 April 2026 / Revised: 12 June 2026 / Accepted: 24 June 2026 / Published: 3 July 2026

(This article belongs to the Special Issue Invisible Wounds: Addressing Veterans' Mental Health Challenges by Centering Their Experiences and Perspectives)

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Abstract

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.

Keywords: mild traumatic brain injury; chronic pain; intermittent theta burst stimulation; lived experience

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MDPI and ACS Style

Kemp, A.M.; Krese, K.; Etingen, B.; Cotner, B.A.; Walker, S.; Kale, I.; Rafferty, M.R.; Kletzel, S.; Shah, R.P.; Bedo, S.; et al. Perspectives Among Veterans with Chronic Pain and Co-Occurring Mild Traumatic Brain Injury: Mixed-Method Findings from a Neuromodulation and Yoga Intervention. Int. J. Environ. Res. Public Health 2026, 23, 872. https://doi.org/10.3390/ijerph23070872

AMA Style

Kemp AM, Krese K, Etingen B, Cotner BA, Walker S, Kale I, Rafferty MR, Kletzel S, Shah RP, Bedo S, et al. Perspectives Among Veterans with Chronic Pain and Co-Occurring Mild Traumatic Brain Injury: Mixed-Method Findings from a Neuromodulation and Yoga Intervention. International Journal of Environmental Research and Public Health. 2026; 23(7):872. https://doi.org/10.3390/ijerph23070872

Chicago/Turabian Style

Kemp, Amy M., Kelly Krese, Bella Etingen, Bridget A. Cotner, Sadie Walker, Ibuola Kale, Miriam R. Rafferty, Sandra Kletzel, Rachana P. Shah, Sabrina Bedo, and et al. 2026. "Perspectives Among Veterans with Chronic Pain and Co-Occurring Mild Traumatic Brain Injury: Mixed-Method Findings from a Neuromodulation and Yoga Intervention" International Journal of Environmental Research and Public Health 23, no. 7: 872. https://doi.org/10.3390/ijerph23070872

APA Style

Kemp, A. M., Krese, K., Etingen, B., Cotner, B. A., Walker, S., Kale, I., Rafferty, M. R., Kletzel, S., Shah, R. P., Bedo, S., Chaudhuri, S., Aaronson, A. L., Donnelly, K. Z., Bobra, S., Billups, A., Yen, P.-S., Bhaumik, D., Bender Pape, T. L., & Herrold, A. A. (2026). Perspectives Among Veterans with Chronic Pain and Co-Occurring Mild Traumatic Brain Injury: Mixed-Method Findings from a Neuromodulation and Yoga Intervention. International Journal of Environmental Research and Public Health, 23(7), 872. https://doi.org/10.3390/ijerph23070872

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Perspectives Among Veterans with Chronic Pain and Co-Occurring Mild Traumatic Brain Injury: Mixed-Method Findings from a Neuromodulation and Yoga Intervention

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