Chronic Pain and PTSD: Evolving Views on Their Comorbidity

Brennstuhl, Marie-Jo; Tarquinio, Cyril; Montel, Sébastien

doi:10.1111/ppc.12093

Cited by 110 publications

(83 citation statements)

References 35 publications

(69 reference statements)

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“…Patients with chronic pain have significantly higher rates of trauma than the general population. Physicians who treat pain patients report high levels of burnout and fatigue (Brennstuhl et al, 2015; Kroll and Macaulay, 2016). While the scope of this present study focuses on behavioral health professionals, increased clinician resilience in providers who treat pain patients could have a meaningful impact on current pain management teams (Kroll and Macaulay, 2016).…”

Section: Discussionmentioning

confidence: 99%

Effect of Somatic Experiencing Resiliency-Based Trauma Treatment Training on Quality of Life and Psychological Health as Potential Markers of Resilience in Treating Professionals

Winblad¹,

Changaris

Stein

2018

Front. Neurosci.

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Background: Individuals who treat trauma are at significant risk of vicarious traumatization and burnout. Somatic Experiencing® (SE®) is a resiliency-focused trauma treatment modality designed to address autonomic nervous system (ANS) dysregulation and its impacted physical health and mental health symptoms e.g., anxiety, depression, post-traumatic stress disorder, migraines, fibromyalgia, and chronic fatigue, etc. The SE® training supports the development of clinical skills to reduce physical health/mental health symptoms as well as increase clinician resilience. Individuals who display resilience often have increased experiences of well-being (quality of life) and decreased levels of self-reported psychological symptoms. Greater resilience could mitigate the risks to providers and the clients they treat.Materials and Methods: This within-groups, longitudinal study assessed students (N = 18) over the course of a 3-year SE® practitioner training. This training focuses on increased ANS, physical, and emotional regulation skills. The convenience of a web-based survey allowed for: measures of a general quality of life (WHOQOL-BREF), psychological symptoms, somatic, anxiety, and depressive symptoms (PHQ-SADS), as well as a measure of early life exposure to adversity (CDC/Kaiser Permanente ACE Score Calculator Questionnaire). The clinician survey was conducted yearly for 3 years. Future studies would do well to also include laboratory-based objective measures of ANS functioning.Results: ANOVA with repeated measures showed that there were significant reductions in anxiety symptoms (GAD7, p < 0.001) and somatization symptoms (PHQ15, p < 0.001). Health-related quality of life (a measure of physical well-being) and social quality of life (a measure of interpersonal well-being) both increased significantly (Health QoL p = 0.028; Social QoL p = 0.046).Conclusions: Results suggest that professionals attending the 3-year SE® training course experience a significant improvement in self-reported measures associated with resiliency including: quality of life (well-being) and psychological symptoms (anxiety and somatization). Our results support the importance of future research in a larger sample and support the exploration, cross-sectionally and prospectively, of the relationship of clinician resiliency and changes in clinician resiliency with SE® training and clinical outcomes. These data have implications for other professions at risk of exposure to vicarious trauma (VT) including nurses, medical providers, and paramedics.

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Section: Discussionmentioning

confidence: 99%

Effect of Somatic Experiencing Resiliency-Based Trauma Treatment Training on Quality of Life and Psychological Health as Potential Markers of Resilience in Treating Professionals

Winblad¹,

Changaris

Stein

2018

Front. Neurosci.

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“…Strong prospective links have been observed between early traumatic experiences and the subsequent development of chronic pain (see 2;25;107 ). We should note that many of these traumatic experiences are social and interpersonal in nature.…”

Section: Psychosocial Factors Influencing Pain-related Outcomesmentioning

confidence: 99%

“…To date, it is not clear whether the association between trauma and later chronic pain is a direct result of exposure to the trauma, is driven predominantly by individual affective, cognitive, and behavioral responses to the traumatic event (e.g., intense fear, avoidance behavior), or is primarily a retrospective attempt at explaining clusters of diverse symptoms for which there may be no immediately apparent etiology. 25 …”

Section: Psychosocial Factors Influencing Pain-related Outcomesmentioning

confidence: 99%

The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain

Edwards

Dworkin

Sullivan

et al. 2016

The Journal of Pain

627

544

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The recently-proposed ACTTION-APS Pain Taxonomy provides an evidence-based, multidimensional, chronic pain classification system. Psychosocial factors play a crucial role within several dimensions of the Taxonomy. In this paper, we discuss the evaluation of psychosocial factors that influence the diagnosis and trajectory of chronic pain disorders. We review studies in individuals with a variety of persistent pain conditions, and describe evidence that psychosocial variables play key roles in conferring risk for the development of pain, in shaping long-term pain-related adjustment, and in modulating pain treatment outcomes. We consider both “general” psychosocial variables such as negative affect, childhood trauma, and social support, as well as “pain-specific” psychosocial variables that include pain-related catastrophizing, self-efficacy for managing pain, and pain-related coping. Collectively, the complexity and profound variability in chronic pain highlights the need to better understand the multidimensional array of interacting forces that determine the trajectory of chronic pain conditions.

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“…A recent systematic review (Brennstuhl, Tarquinio, & Montel, 2015) included all studies on the relationship between chronic pain and PTSD in populations without any specific underlying somatic disorder and found 24 articles meeting the inclusion criteria. Of these articles, only one study (Otis et al, 2010) recruited participants from a pain management programme.…”

Section: Introductionmentioning

confidence: 99%

Post-traumatic stress disorder moderates the relationship between trauma exposure and chronic pain

Siqveland

Ruud

Hauff

2017

European Journal of Psychotraumatology

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Background: Trauma exposure and post-traumatic stress disorder (PTSD) are risk factors for chronic pain. Objective: This study investigated how exposure to intentional and non-intentional traumatic events and PTSD are related to pain severity and outcome of treatment in chronic pain patients. Methods: We assessed exposure to potentially traumatizing events, psychiatric diagnosis with structured clinical interview, and pain severity in 63 patients at a secondary multidisciplinary pain clinic at the beginning of treatment, and assessed level of pain at follow up. Exposure to potentially traumatizing events and PTSD were regressed on pain severity at the initial session and at follow up in a set of multiple regression analysis. Results: The participants reported exposure to an average of four potentially traumatizing events, and 32% had PTSD. Exposure to intentional traumatic events and PTSD were significantly associated with more severe pain, and PTSD significantly moderated the relationship between trauma exposure and pain (all p < .05). The treatment programme reduced pain moderately, an effect that was unrelated to trauma exposure and PTSD. Conclusions: Trauma exposure is related to chronic pain in the same pattern as to mental disorders, with intentional trauma being most strongly related to pain severity. PTSD moderated the relationship between trauma exposure and pain. While pain patients with PTSD initially report more pain, they responded equally to specialist pain treatment as persons without PTSD.

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Chronic Pain and PTSD: Evolving Views on Their Comorbidity

Abstract: Various forms of therapy and treatment focus on PTSD, but chronic pain symptoms must also be assessed.

Cited by 110 publications

References 35 publications

Effect of Somatic Experiencing Resiliency-Based Trauma Treatment Training on Quality of Life and Psychological Health as Potential Markers of Resilience in Treating Professionals

Effect of Somatic Experiencing Resiliency-Based Trauma Treatment Training on Quality of Life and Psychological Health as Potential Markers of Resilience in Treating Professionals

The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain

Post-traumatic stress disorder moderates the relationship between trauma exposure and chronic pain

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