Comorbid Chronic Pain and Posttraumatic Stress Disorder: Current Knowledge, Treatments, and Future Directions

Reed, David E.; Cobos, Briana; Nabity, Paul S; Doolin, Jesse; McGeary, Donald D.

doi:10.1016/b978-0-323-72216-2.00015-6

Cited by 9 publications

(21 citation statements)

References 125 publications

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“…The present study found a high prevalence of pain among this sample of individuals with PTSD, in keeping with other published data demonstrating high rates of comorbid pain and PTSD ( 40 ). Statistically significant within subjects reductions in CPGS subscales including pain intensity, disability score, and composite chronic pain severity grade were observed following MDMA-AT among participants in the highest pain cluster ( n = 9), and for pain intensity only in the medium pain cluster ( n = 11), suggesting that MDMA-AT may be associated with reduction in chronic pain and pain-related disability.…”

Section: Discussionsupporting

confidence: 92%

MDMA-assisted therapy is associated with a reduction in chronic pain among people with post-traumatic stress disorder

et al. 2022

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IntroductionIncreasing evidence demonstrates 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy (MDMA-AT) may be a safe and effective treatment for post-traumatic stress disorder (PTSD). There is growing interest in MDMA-AT to address a range of other health challenges. Chronic pain and PTSD are frequently comorbid, reciprocally interdependent conditions, though the possible role of MDMA-AT in treating chronic pain remains under-investigated. The present analysis examined the impact of manualized MDMA-AT on chronic pain severity among participants with PTSD who were enrolled in a Phase 2 clinical trial investigating MDMA-AT for PTSD (NCT03282123).Materials and methodsExploratory data from a subset of participants who completed chronic pain measures (n = 32) were drawn from a Phase 2 open-label study sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). Multivariable analysis of variance (ANOVA) was utilized to compare pre- vs. post-treatment Chronic Pain Grade Scale (CPGS) values, adjusting for demographics (age, sex, and ethnicity). K-means clustering was then used to group the sample into three clusters to denote high (n = 9), medium (n = 11), and low (n = 12) baseline pain severity, and the same analysis was repeated for each cluster.ResultsAmong the 32 participants included in this analysis, 59% (n = 19) were women, 72% (n = 23) were white, and median age was 38 years [interquartile range (IQR) = 31–47]. Overall, 84% (n = 27) reported having pain, and 75% (n = 24) reported disability associated with their pain. Significant reductions in CPGS subscales for pain intensity and disability score, and overall CPGS severity grade were observed among participants in the highest pain cluster (n = 9, p < 0.05), and for pain intensity in the medium pain cluster (n = 11, p < 0.05) post- vs. pre-treatment.DiscussionFindings demonstrate a high prevalence of chronic pain in this sample of people with severe PTSD and that chronic pain scores among medium and high pain subgroups were significantly lower following MDMA-AT. While these data are preliminary, when considered alongside the frequency of comorbid chronic pain and PTSD and promising efficacy of MDMA-AT for treating PTSD, these findings encourage further research exploring the role of MDMA-AT for chronic pain.

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Section: Discussionsupporting

confidence: 92%

MDMA-assisted therapy is associated with a reduction in chronic pain among people with post-traumatic stress disorder

et al. 2022

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“…Chronic pain, defined as experiencing consistent pain for at least 3 months (Treed et al, 2015), and PTSD are partially characterized by several processes, including avoidance of pain or PTSD-specific stimuli (e.g. thoughts about the trauma), negative affect, and disruption of identity (Ravn et al, 2018; Reed et al, 2021; Sharp and Harvey, 2001). A combination of pharmacological and non-pharmacological treatments is recommended for both disorders when treated separately (American Psychological Association, 2017; Gatchel et al, 2014).…”

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confidence: 99%

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

et al. 2021

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There is a knowledge gap when treating comorbid chronic pain and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic. Addressing this gap, 169 individuals (57.4% female), aged 39.8 years were recruited based on levels of pain-related disability and PTSD symptoms. Participants were assessed prior to, and during, the COVID-19 pandemic. Improvements in pain-related disability were marginally attenuated for the comorbid group, compared to the chronic pain group. Results show that some condition-specific symptoms may not have been affected by the COVID-19 pandemic. Cautious interpretation is warranted due to only two time points and the lack of a diverse sample.

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“…Qualitative research and theoretical considerations highlight how individuals with chronic pain are forced to alter how they engage with the world, potentially causing identity-related distress ( Smith and Osborn, 2007 ; Morley, 2008 ; Reed et al, 2021 ). Chronic pain compels individuals to find new ways of engaging authentically.…”

Section: Discussionmentioning

confidence: 99%

“…The present work suggests that, although individuals with chronic pain may also struggle to recognize their emotions (Aaron et al, 2019), the addition of PTSD adds a layer that may prevent one's authentic self from buffering CV-19 Threat. Qualitative research and theoretical considerations highlight how individuals with chronic pain are forced to alter how they engage with the world, potentially causing identity-related distress (Smith and Osborn, 2007;Morley, 2008;Reed et al, 2021). Chronic pain compels individuals to find new ways of engaging authentically.…”

Section: Discussionmentioning

confidence: 99%

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Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder

et al. 2021

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ObjectiveThe novel coronavirus (2019; CV-19) is linked to increases in emotional distress and may be particularly problematic for those with pre-existing mental and physical conditions, such as chronic pain and posttraumatic stress disorder (PTSD). However, little empirical research has been published on resilience factors in these individuals. The present study aims to examine authenticity as a resilience factor among those with chronic pain and/or PTSD.MethodsPrior to the national response to the pandemic (January 10-24, 2020), participants were screened for pain-related disability (Oswestry Disability Index; ODI) and PTSD symptoms (Posttraumatic Checklist for DSM-5; PCL-5), and on the basis of those responses were categorized into one of four groups: healthy, chronic pain only, PTSD only, or comorbid chronic pain and PTSD. During the CV-19 pandemic (May 5-May 13, 2020), participants responded again to the ODI and PCL-5, in addition to the Wood Authenticity Scale, Brief Pain Inventory, and items related to the CV-19 pandemic.ResultsA total of 110 participants (54.55% women), aged 42.19 (SD = 13.16), completed the survey during the pandemic. The comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Authenticity moderated this relationship relevant to CV-19 Threat among those in the chronic pain only group, and not in any other group.ConclusionThe comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Importantly, greater authenticity was associated with less CV-19 Threat in the chronic pain only group, and not in any other group. The present study also highlights the importance of engaging authentically for those with chronic pain during the pandemic.

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Comorbid Chronic Pain and Posttraumatic Stress Disorder: Current Knowledge, Treatments, and Future Directions

Cited by 9 publications

References 125 publications

MDMA-assisted therapy is associated with a reduction in chronic pain among people with post-traumatic stress disorder

MDMA-assisted therapy is associated with a reduction in chronic pain among people with post-traumatic stress disorder

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

Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder

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