Comorbid Post Traumatic Stress Disorder, Pain and Opiate Addiction

Abstract

Being exposed to life-threatening physical traumas, for example, a motor vehicle accident or combatrelated injury, may also contribute to the development of chronic physical pain and PTSD. The use of opiates to treat chronic pain may result in the development of opiate addiction. Therefore, PTSD, pain, and opiate addiction commonly co-occur. The signs and symptoms of these disorders may overlap, which can make it challenging to determine which led to which. For example, the opioid withdrawal syndrome may mimic the hypervigilance and exacerbated startle response in patients with PTSD. A common neurobiological circuit is suggested for the pathophysiologic mechanism of this comorbidity. There is evidence that opioid substitution therapy may improve opioid addiction and chronic pain outcomes in patients with comorbid PTSD, pain, and opioid use disorder. Further, non-pharmacological approaches utilizing cognitive behavioral therapy (CBT) show promise in addressing the treatment needs of those with co-occurring PTSD, pain, and opioid use disorder; however, additional research is needed to validate these results. In this chapter, the prevalence and etiology of these comorbidities will be reviewed. The neurobiological link between PTSD, pain, and opiate addiction will be discussed. The available treatment options for these comorbidities with a focus on illicit opiate use, PTSD, and pain outcomes will be elaborated. The reader will be updated about the basic and most recent information available about these comorbidities. Then the gap in the current treatment and the need for future research will be mentioned.