An Examination of Chronic Pain Indices and the Updated Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental-Disorders-Fifth Edition

Abstract

Introduction Chronic pain and post-traumatic stress disorder (PTSD) comorbidity is prevalent among veterans and is associated with increased levels of pain severity and pain-related disability. An improved understanding of the relationship between these co-occurring disorders, in addition to effective integrated treatments, will develop by considering the changes to the PTSD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The current study examined the relationship between the revised PTSD Checklist for DSM-5 (PCL-5) symptom clusters (i.e., intrusion, avoidance, negative alterations in cognition and mood [NACM], and arousal) and chronic pain measurements (i.e., pain severity, interference, and disability). Materials and Methods Participants included 103 veterans (ages 26-70, mean = 45.33) participating in a randomized clinical trial examining the efficacy of an interdisciplinary pain management program for chronic musculoskeletal pain. The study was approved by a university system Institutional Review Board and affiliated healthcare system. Results The participants with a provisional PTSD diagnosis based on PCL-5 responses (N = 76) had significantly greater pain severity, interference, and disability than the participants without a provisional diagnosis (N = 23). Correlations between symptom clusters and pain measurements were mostly significant and positive with varying strengths. The avoidance symptom cluster, however, had relatively weaker correlations with pain measurements and was not significantly associated with the numeric rating scale of pain severity. Path analyses revealed that, after controlling for avoidance symptoms, significant associations remained between NACM and all the pain measurements. After controlling for NACM symptoms, however, there were no significant associations between avoidance symptoms and pain measurements. Conclusion The current study highlights a need to re-examine the leading theories about the mutual maintenance of these disorders in order to develop effective integrative treatment approaches. PTSD-related avoidance may have a relatively weaker role in co-occurring chronic pain than the other symptom clusters and may have a qualitatively different role than chronic pain–related avoidance. Future research should explore the relationship between the avoidance in PTSD and the avoidance in chronic pain as well as identify which chronic pain measurements are the most useful when examining the relationship between PTSD and chronic pain. The potential impact of trauma-related cognition and mood on chronic pain indicates that this is an important area for intervention and should be considered in the development of integrated treatments for chronic pain and PTSD among veterans.

Pain-related disability, PTSD symptoms, and mood among a comorbid chronic pain and PTSD sample prior to and during the COVID-19 pandemic

“…The combination of chronic pain and PTSD is particularly problematic for multiple reasons. Comorbid chronic pain and PTSD are highly prevalent (Akhtar et al, 2019; Asmundson et al, 2002; Hooten, 2016) and associated with higher pain severity, pain-related disability, medication use, and mental health services use compared to chronic pain only (Akhtar et al, 2019; Lehinger et al, 2020; Outcalt et al, 2014). Among PTSD populations, those with chronic pain are more likely to report higher pain severity and PTSD symptoms (Beckham et al, 1997; Shipherd et al, 2007).…”

Introducing the integrated model of co-occurring chronic pain and posttraumatic stress disorder: Adding meaning-making and existential concepts to current theory.

“…Chronic pain alone affects millions of individuals in the United States, and the prevalence of PTSD within this population may be as high as 50% in specialty settings (Gaskin & Richard, 2012; Otis et al, 2010). For those with chronic pain, PTSD is linked to more pain intensity, pain-related disability, and negative cognitive appraisals (Benedict et al, 2020; Lehinger et al, 2021). Similarly, for those with PTSD, chronic pain is associated with more primary care and pain specialty care use, in addition to more opioid and antidepressant use (Outcalt et al, 2014).…”

Risk factors for post-traumatic stress disorder in nurses from the regional medical alliance during the COVID-19 epidemic: A prospective cross-sectional study

“…Post-traumatic stress disorder (PTSD) is a psychological condition that arises following exposure to or witnessing unusually catastrophic or threatening traumatic events or situations [ 1 , 2 ]. PTSD is characterized by difficulties in daily functioning due to recurring flashbacks or uncontrollable thoughts of past traumatic events, avoidance of trauma-related stimuli, and heightened vigilance [ 2 , 3 ]. The prolonged course of PTSD can detrimentally affect psychological wellbeing, social functioning, and quality of life [ 1 ].…”