Chronic pain patients with possible co-morbid post-traumatic stress disorder admitted to multidisciplinary pain rehabilitation—a 1-year cohort study

Andersen, Tonny Elmose; Andersen, Lou-Ann Christensen; Andersen, Per Grünwald

doi:10.3402/ejpt.v5.23235

Cited by 33 publications

(31 citation statements)

References 36 publications

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“…Our findings support this. This is also in agreement with many other studies reporting that chronic pain patients with PTSD symptoms report more pain and disability when compared to patients without, both in WAD (Pedler & Sterling, 2013) and in other pain conditions (Aakerblom, Perrin, Rivano, Fischer, & McCracken, 2017;Andersen, Andersen, & Andersen, 2014;Ruiz-Párraga & López-Martínez, 2014). This is also in accordance with longitudinal studies finding initial PTSD levels predictive of WAD severity one year post-injury (Buitenhuis et al, 2006;Kongsted et al, 2008).…”

Section: Significant Differences P-valuessupporting

confidence: 92%

Trajectories of posttraumatic stress symptoms after whiplash: A prospective cohort study

Ravn

Karstoft

Sterling

et al. 2018

European Journal of Pain

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Background Posttraumatic stress disorder (PTSD) symptoms are highly prevalent after whiplash and associated with pain‐related symptoms. While mutual maintenance between pain and PTSD has been suggested, knowledge on individual differences in the course of these symptoms is needed. The present study aimed to identify trajectories of PTSD symptoms following whiplash and test predictors and functional outcomes of such trajectories. Methods In a prospective cohort design with assessments at baseline (<4 weeks), 3 months, and 6 months post‐injury (n = 229, whiplash grade I‐III), we identified PTSD‐trajectories using Latent Growth Mixture Modeling. Predictors (pain, fear‐avoidance‐beliefs, pain‐catastrophizing, depression, age, and gender) were tested using multinomial logistic regression, and group mean differences in physical and psychosocial pain‐related disability at 6 months were tested as outcomes after controlling for baseline levels. Results Three trajectories were identified: “Resilient” (75.1%) with little or no PTSD symptoms over time, “Recovering” (10.0%) with high initial PTSD symptom levels, then decreasing substantially, and “Chronic” (14.9%) with high initial PTSD symptom levels and a small increase over time. Initial higher pain and depression levels predicted the recovering and chronic trajectories, while the latter had more pain‐related disability at 6 months compared to both other trajectories. Conclusions Three trajectories were identified, with the chronic trajectory suggesting that a significant subset of people does not recover from PTSD symptoms. This class also reported more pain‐related disability. Pain and depression predicted membership, but did, however, not succeed in differentiating between the two high‐starting trajectories, suggesting that targeting PTSD symptoms may be important to ensure recovery. Significance Distinct recovery patterns after whiplash were identified with a significant subgroup reporting elevated and slightly increasing PTSD symptoms over time, highlighting both recovery variability and the presence of PTSD symptoms in a significant subgroup of individuals with whiplash. This subgroup also displayed enhanced pain‐related disability over time compared to the recovering and resilient subgroups, thereby linking PTSD symptoms to functional pain outcomes over time. These findings suggest that clinicians should be attentive of potential PTSD symptoms in whiplash patients.

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Section: Significant Differences P-valuessupporting

confidence: 92%

Trajectories of posttraumatic stress symptoms after whiplash: A prospective cohort study

Ravn

Karstoft

Sterling

et al. 2018

European Journal of Pain

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“…According to the mutual maintenance theory, pain in persons with chronic pain should be less responsive to treatment because PTSD is supposed to be a driver for continued pain thorough a self-reinforcing cycle of arousal and avoidance (Sharp & Harvey, 2001). On the other hand this is also what Andersen et al (2014) found in their study of chronic pain patients with PTSD.…”

Section: Discussionsupporting

confidence: 82%

“…Vedantham et al (2001) found in a study of Canadian bus drivers that trauma exposure was related to later somatic complaints only in persons with PTSD. Also, Andersen, Andersen, and Andersen (2014) found that persons with comorbid chronic pain and PTSD had significantly poorer health, poorer sleep quality, more cognitive problems and lower social functioning compared to pain patients without PTSD. While PTSD diagnosis has sometimes been heavily criticized for lacking in validity and clinical utility (McHugh & Treisman, 2007; Rosen, Spitzer, & McHugh, 2008), this study indicated that the PTSD diagnosis is useful in indexing persons who have the most severe health problems after trauma exposure.…”

Section: Discussionmentioning

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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“…Higher levels of emotional distress, depression and anxiety at baseline have been associated with poorer outcomes in cognitive behavioural therapy (CBT) for chronic pain (Linton et al, ; Miles et al, ; Trompetter, Bohlmeijer, Lamers, & Schreurs, ; Turner, Holtzman, & Mancl, ), although a few studies have presented contradictory findings for depression (Davis & Zautra, ; Wetherell et al, ). We are only aware of three studies investigating whether baseline levels of PTSD predict pain outcomes in treatments for chronic pain, and these generally found no relationship (Andersen, Andersen, & Andersen, ; Herbert et al, ; Siqveland, Ruud, & Hauff, ).…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes in group‐based cognitive behavioural therapy for chronic pain: An examination of PTSD symptoms

Åkerblom

Perrin

Fischer

et al. 2020

European Journal of Pain

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Background The relevance of post‐traumatic stress disorder (PTSD) symptoms to outcomes of cognitive behavioural therapy (CBT) for chronic pain is unclear. This study examines whether (a) traumatic exposure or the severity of PTSD symptoms at pre‐treatment predicts the outcomes (pain intensity/interference), (b) participation in this treatment is associated with reduced PTSD symptoms and (c) any observed changes in PTSD symptoms are mediated by changes in psychological mechanisms that have been shown to be of importance to PTSD and chronic pain. Methods Participants were 159 chronic pain patients who were consecutively admitted for a multidisciplinary, group‐based CBT program at the Pain Rehabilitation Unit at Skåne University Hospital. A self‐report measure of traumatic exposure and PTSD symptoms was administered before and after treatment, and at a 12‐month follow‐up, along with measures of depression, anxiety, pain intensity, pain interference, psychological inflexibility, life control and kinesiophobia. Results Traumatic exposure and PTSD symptom severity did not predict pain intensity or interference at 12‐month follow‐up. There were no overall significant changes in PTSD symptom severity at post‐treatment or follow‐up, but 24.6% of the participants showed potential clinically significant change at follow‐up. Psychological inflexibility mediated the changes that occurred in PTSD symptoms during treatment. Conclusions Neither traumatic exposure nor baseline symptoms of PTSD predicted the treatment outcomes examined here. Despite improvements in both comorbid depression and anxiety, participation in this pain‐focused CBT program was not associated with improvements in comorbid PTSD. To the extent that changes in PTSD symptoms did occur, these were mediated by changes in psychological inflexibility during treatment. Significance Pain‐focused CBT programs yield clinically meaningful improvements in pain and comorbid symptoms of depression and anxiety, but may have little effect on comorbid PTSD. This raises the issue of whether current pain‐focused CBT programs can be modified to improve outcomes for comorbid conditions, perhaps by better targeting of psychological flexibility, and/or whether separate treatment of PTSD may be associated with improved pain outcomes.

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Chronic pain patients with possible co-morbid post-traumatic stress disorder admitted to multidisciplinary pain rehabilitation—a 1-year cohort study

Cited by 33 publications

References 36 publications

Trajectories of posttraumatic stress symptoms after whiplash: A prospective cohort study

Trajectories of posttraumatic stress symptoms after whiplash: A prospective cohort study

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

Treatment outcomes in group‐based cognitive behavioural therapy for chronic pain: An examination of PTSD symptoms

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