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The Interaction Between Chronic Pain and PTSD

  • Psychological and Behavioral Aspects of Headache and Pain (D Buse, Section Editor)
  • Published:
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Abstract

Purpose of Review

Post-traumatic stress disorder (PTSD) and chronic pain often co-occur. Understanding the shared mechanisms, signs to identify PTSD, and treatment options is integral in allowing providers to better serve their patients.

Recent Findings

Individuals with comorbid PTSD and chronic pain report greater PTSD symptoms, pain, anxiety, depression, disability, and opioid use than those with only one of these conditions. There are several empirically supported therapies for chronic pain, and for PTSD, as well as pilot data for a treatment of comorbid pain and PTSD.

Summary

The purpose of this paper is to review and synthesize current literature investigating the interaction between chronic pain and PTSD, and provide treatment recommendations for providers treating patients with chronic pain and PTSD.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Merskey H, Albe Fessard D, Bonica JJ, Carmon A, Dubner R, Kerr FWL, Lindblom U, Mumford JM, Nathan PW, Noordenbos W, Pagni CA, Renaer MJ, Sternbach RA, Sunderland S. Pain terms: a list with definitions and notes on usage. Recommended by the IASP subcommittee on taxonomy. PAIN 1979;6:249–52.

  2. Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2015;136:380–7.

    Article  Google Scholar 

  3. Dubois MY, Follett KA. Pain medicine: the case for an independent medical specialty and training programs. Acad Med. 2014;89:863–8.

    Article  Google Scholar 

  4. Gaskin D, Richard P. The economic costs of pain in the United States. J Pain. 2012;13:715–24. https://doi.org/10.1016/j.jpain.2012.03.009.

    Article  PubMed  Google Scholar 

  5. Nahin RL. Severe pain in veterans: the effect of age and sex, and comparisons with the general population. J Pain. 2017;18:247–54.

    Article  Google Scholar 

  6. Wiech K, Tracey I. The influence of negative emotions on pain: behavioral effects and neural mechanisms. Neuroimage. 2009;47:987–94.

    Article  Google Scholar 

  7. Asmundson GJG, Katz J. Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art. Depress Anxiety. 2009;26:88–901. https://doi.org/10.1002/da.20600.

    Article  Google Scholar 

  8. Staerkle R, Mannion AF, Elfering A, Junge A, Semmer NK, Jacobshagen N, et al. Longitudinal validation of the Fear-Avoidance Beliefs Questionnaire (FABQ) in a Swiss-German sample of low back pain patients. Eur Spine J. 2004;13:332–40. https://doi.org/10.1007/s00586-003-0663-3.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Elliott TE, Renier CM, Palcher JA. Chronic pain, depression, and quality of life: correlations and predictive value of the SF-36. Pain Med. 2003;4:331–9. https://doi.org/10.1111/j.1526-4637.2003.03040.x.

    Article  PubMed  Google Scholar 

  10. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163:2433–45. https://doi.org/10.1001/archinte.163.20.2433.

    Article  PubMed  Google Scholar 

  11. Collado A, Gomez E, Coscolla R, Sunyol R, Solé E, Rivera J, et al. Work, family and social environment in patients with fibromyalgia in Spain: an epidemiological study: EPIFFAC study. BMC Health Serv Res. 2014;14:513–5.

    Article  Google Scholar 

  12. Ojeda B, Salazar A, Dueñas M, Torres L, Micó J, Failde I. The impact of chronic pain: the perspective of patients, relatives, and caregivers. Fam Syst Health. 2014;32:399–407.

    Article  Google Scholar 

  13. Vlaeyen JS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317–32. https://doi.org/10.1016/S0304-3959(99)00242-0.

    Article  CAS  PubMed  Google Scholar 

  14. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

  15. Goldstein RB, Smith SM, Chou SP, Saha TD, Jung J, Zhang H, et al. The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol. 2016;51:1137.

    Article  Google Scholar 

  16. • Fishbain DA, Pulikal A, Lewis JE, Gao J. Chronic pain types differ in their reported prevalence of post-traumatic stress disorder (PTSD) and there is consistent evidence that chronic pain is associated with PTSD: an evidence-based structured systematic review. Pain Med. 2017;18:711–35. https://doi.org/10.1093/pm/pnw065 Review of PTSD prevalence across pain types.

    Article  PubMed  Google Scholar 

  17. •• Siqveland J, Hussain A, Lindstrøm JC, Ruud T, Hauff E. Prevalence of posttraumatic stress disorder in persons with chronic pain: a meta-analysis. Front Psychiatry. 2017;8:1–8. https://doi.org/10.3389/fpsyt.2017.00164 Prevalence of PTSD in individuals with chronic pain.

    Article  Google Scholar 

  18. Noel M, Wilson AC, Holley AL, Durkin L, Patton M, Palermo TM. Posttraumatic stress disorder symptoms in youth with vs without chronic pain. Pain. 2016;157:2277–84. https://doi.org/10.1097/j.pain.0000000000000642.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jenewein J, Wittmann L, Moergeli H, Creutzig J, Schnyder U. Mutual influence of posttraumatic stress disorder symptoms and chronic pain among injured accident survivors: a longitudinal study. J Trauma Stress. 2009;22:540–8. https://doi.org/10.1002/jts.20453.

    Article  CAS  PubMed  Google Scholar 

  20. Outcalt SDP, Kroenke K, Krebs EE, Chumbler NR, Wu J, Yu Z, et al. Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life. J Behav Med. 2015;38:535–43. https://doi.org/10.1007/s10865-015-9628-3.

    Article  PubMed  Google Scholar 

  21. Sullivan MJL, Thibault P, Simmonds MJ, Milioto M, Cantin AP, Velly AM. Pain, perceived injustice and the persistence of post-traumatic stress symptoms during the course of rehabilitation for whiplash injuries. Pain. 2009;145:325–31.

    Article  Google Scholar 

  22. Rosenthal JF, Erickson JC. Post-traumatic stress disorder in U.S. soldiers with post-traumatic headache. Headache. 2013;53:1564–72. https://doi.org/10.1111/head.12200.

    Article  PubMed  Google Scholar 

  23. Campbell G, Darke S, Bruno R, Degenhardt L. The prevalence and correlates of chronic pain and suicidality in a nationally representative sample. Aust N Z J Psychiatry. 2015;49:803–11.

    Article  Google Scholar 

  24. Barlow DH. Anxiety and its disorders. 2nd ed: New York: The Guilford Press; 2002.

  25. Otis JD, Keane TM, Kerns RD. An examination of the relationship between chronic pain and post-traumatic stress disorder. J Rehabil Res Dev. 2003;40:397–405.

    Article  Google Scholar 

  26. Cornelis MC, Nugent NR, Amstadter AB, Koenen KC. Genetics of post-traumatic stress disorder: review and recommendations for genome-wide association studies. Curr Psychiatry Rep. 2010;12:313–26. https://doi.org/10.1007/s11920-010-0126-6.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jacobsen LM, Schistad EI, Storesund A, Pedersen LM, Rygh LJ, Røe C, et al. The MMP1 rs1799750 2G allele is associated with increased low back pain, sciatica, and disability after lumbar disk herniation. Clin J Pain. 2013;29:967–71. https://doi.org/10.1097/AJP.0b013e31827df7fd.

    Article  PubMed  Google Scholar 

  28. James SK. Chronic postsurgical pain: is there a possible genetic link? Br J Pain. 2017;11:178–85.

    Article  Google Scholar 

  29. Bryant RA, Guthrie RM. Maladaptive self-appraisals before trauma exposure predict posttraumatic stress disorder. J Consult Clin Psychol. 2007;75:812–5.

    Article  Google Scholar 

  30. Alschuler KN, Otis JD. Coping strategies and beliefs about pain in veterans with comorbid chronic pain and significant levels of posttraumatic stress disorder symptoms. Eur J Pain. 2012;16:312–9. https://doi.org/10.1016/j.ejpain.2011.06.010.

    Article  CAS  PubMed  Google Scholar 

  31. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psych Bull. 2007;133:581–684.

    Article  Google Scholar 

  32. Otis JD. Managing Chronic Pain. Oxford: clinical psychology; 2007.

  33. Cleeland CS, Ryan KM. Pain assessment: global use of the brief pain inventory. Ann Acad Med. 1994;23:129–38.

    CAS  Google Scholar 

  34. Krebs EE, Lorenz KA, Bair MJ, Damush TM, Wu J, Sutherlan JM, et al. Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. J Gen Intern Med. 2009;24:733–8.

    Article  Google Scholar 

  35. Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7:524–32.

    Article  Google Scholar 

  36. Prins A, Bovin MJ, Kimerling R, Kaloupek DG, Marx BP, Pless Kaiser A, & Schnurr PP. The primary care PTSD screen for DSM-5 (PC-PTSD-5). 2015. [Measurement instrument].

  37. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, & Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). 2013. Scale available from the National Center for PTSD at www.ptsd.va.gov. Accessed 21 Nov 2019.

  38. Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012;11. https://doi.org/10.1002/14651858.CD007407.pub3.

  39. Velleman S, Stallard P, Richardson T. A review and meta-analysis of computerized cognitive behaviour therapy for the treatment of pain in children and adolescents. Child Care Health Dev. 2012;36:465–72.

    Article  Google Scholar 

  40. Wetherell JL, Afari N, Ayers CR, Stoddard JA, Ruberg J, Sorrell JT, et al. Acceptance and commitment therapy for generalized anxiety disorder in older adults: a preliminary report. Behav Ther. 2011;42:127–34.

    Article  Google Scholar 

  41. Hughes LS, Clark J, Colclough JA, Dale E, McMillan D. Acceptance and commitment therapy (ACT) for chronic pain: a systematic review and meta-analyses. Clin J Pain. 2017;33:552–68.

    Article  Google Scholar 

  42. • Rutt BT, Oehlert ME, Krieshok TS, Lichtenbberg JW. Effectiveness of cognitive processing therapy and prolonged exposure in the department of veterans affairs. Psychol Rep. 2018;121:282–302 Comparison of PE and CPT for PTSD.

    Article  Google Scholar 

  43. Foa EB. Prolonged exposure therapy: past, present and future. Depress Anxiety. 2011;28:1043–7.

    Article  Google Scholar 

  44. Resick PA, Schnicke MK. Cognitive processing therapy for sexual assault victims. J Consult Clin Psychol. 1992;60:748–56.

    Article  CAS  Google Scholar 

  45. Otis JD, Keane TM, Kerns RD, Monson C, Scioli E. The development of an integrated treatment for veterans with comorbid chronic pain and posttraumatic stress disorder. Pain Med. 2009;10:1300–11. https://doi.org/10.1111/j.1526-4637.2009.00715.x.

    Article  PubMed  Google Scholar 

  46. •• Otis JD, Comer JS, Scioli-Salter E, Keane T, & Pincus D. P. (Under Review). Intensive treatment of chronic pain and PTSD: the PATRIOT Program. Study of combined PTSD and chronic pain treatment.

  47. Hazlett-Stevens H, Craske MG. Brief cognitive-behavioral therapy: definition and scientific foundations. In: Bond FW, Dryden W, editors. Handbook of brief cognitive behavioral therapy: Wiley Online Library; 2002.

  48. Morisette SB, Spiegel DA, Heinrichs N. Sensation-focused intensive treatment for panic disorder with moderate to severe agoraphobia. Cogn Behav Pract. 2005;12:17–29. https://doi.org/10.1016/S1077-7229(05)80036-7.

    Article  Google Scholar 

  49. Deacon B, Abramowitz J. A pilot study of two-day cognitive-behavioral therapy for panic disorder. Behav Res Ther. 2006;44:807–17. https://doi.org/10.1016/j.brat.2005.05.008.

    Article  PubMed  Google Scholar 

  50. Cochran G, Bacci JL, Ylioja T, Hruschak V, Miller S, Seybert AL, et al. Prescription opioid use: patient characteristics and misuse in community pharmacy. J Am Pharm Assoc. 2016;56:248–56. https://doi.org/10.1016/j.japh.2016.02.012.

    Article  Google Scholar 

  51. Bohnert AS, Ilgen MA, Galea S, McCarthy JF, Blow FC. Accidental poisoning mortality among patients in the Department of Veterans Affairs Health System. Med Care. 2011;49:393–6. https://doi.org/10.1097/MLR.0b013e318202aa27.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Suffolk University, Boston, MA, USA

    Shelley Kind

  2. United States of America Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA

    John D. Otis

  3. Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02115, USA

    John D. Otis

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  1. Shelley Kind
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Correspondence to John D. Otis.

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Kind, S., Otis, J.D. The Interaction Between Chronic Pain and PTSD. Curr Pain Headache Rep 23, 91 (2019). https://doi.org/10.1007/s11916-019-0828-3

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