Increased Pain Sensitivity in Accident-related Chronic Pain Patients With Comorbid Posttraumatic Stress

Vægter, Henrik Bjarke; Andersen, Tonny Elmose; Harvold, Mathea; Andersen, Per Grünwald; Graven‐Nielsen, Thomas

doi:10.1097/ajp.0000000000000543

Cited by 33 publications

(17 citation statements)

References 36 publications

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“…A past fall could result in a persistent fear or anxiety response which negatively impacts perceived postural stability (Dieterich and Staab 2017). It is possible that the prior fall resulted in hyper-vigilance and the context of the balance testing paradigm increased the stress level of some participants (possibly via perceived threat) leading to a more negative perception of postural stability (Vaegter et al 2018). Additionally, a prior fall may result in catastrophizing thoughts that bias perception in a negative way (Delbaere et al 2009).…”

Section: Discussionmentioning

confidence: 99%

Community-dwelling adults with a history of falling report lower perceived postural stability during a foam eyes closed test than non-fallers

et al. 2019

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Perceived postural stability has been reported to decrease as sway area increases on firm surfaces. However, changes in perceived stability under increasingly challenging conditions (e.g. removal of sensory inputs) and the relationship with sway area are not well characterized. Moreover, whether perceived stability varies as a function of age or history of falls is unknown. Here we investigate how perceived postural stability is related to sway area and whether this relationship varies as a function of age and fall history while vision and proprioceptive information are manipulated. Sway area was measured in 426 participants from the Baltimore Longitudinal Study of Aging while standing with eyes open and eyes closed on the floor and a foam cushion. Participants rated their stability [0 (completely unstable) to 10 (completely stable)] after each condition, and reported whether they had fallen in the past year. Perceived stability was negatively associated with sway area (cm^2) such that individuals who swayed more felt less stable across all conditions (β = −0.53, p < 0.001). Perceived stability decreased with increasing age (β = −0.019, p < 0.001), independent of sway area. Fallers had a greater decline in perceived stability across conditions (F = 2.76, p = 0.042) compared to non-fallers, independent of sway area. Perceived postural stability declined as sway area increased during a multi-sensory balance test. A history of falling negatively impacts perceived postural stability when vision and proprioception are simultaneously challenged. Perceived postural stability may provide additional information useful for identifying individuals at risk of falls.

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Section: Discussionmentioning

confidence: 99%

Community-dwelling adults with a history of falling report lower perceived postural stability during a foam eyes closed test than non-fallers

et al. 2019

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“…Those with both PTSD and chronic physical symptoms report greater severity of symptoms (Morasco et al, 2013;Vaegter, Andersen, Harvold, Andersen, & Graven-Nielsen, 2017), worse prognosis (Morasco et al, 2013;Rosenbloom, Khan, McCartney, & Katz, 2013) and greater disability (Akerblom, Perrin, Rivano Fischer, & McCracken, 2017;Martin, Halket, Asmundson, Flora, & Katz, 2010;Outcalt et al, 2015) than those with only PTSD symptoms or only physical symptoms. This comorbidity also complicates treatment efforts, leading to lower engagement with treatment (Outcalt, Hoen, Yu, Franks, & Krebs, 2016) and greater opioid use (Seal et al, 2012) as compared to those with only one condition.…”

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confidence: 99%

Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment

McAndrew

Phillips

et al. 2019

European Journal of Psychotraumatology

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Background : The mutual maintenance model proposes that post-traumatic stress disorder (PTSD) symptoms and chronic physical symptoms have a bi-directional temporal relationship. Despite widespread support for this model, there are relatively few empirical tests of the model and these have primarily examined patients with a traumatic physical injury. Objective : To extend the assessment of this model, we examined the temporal relationship between PTSD and physical symptoms for military personnel deployed to combat (i.e., facing the risk of death) who were not evacuated for traumatic injury. Methods : The current study used a prospective, longitudinal design to understand the cross-lagged relationships between PTSD and physical symptoms before, immediately after, 3 months after, and 1 year after combat deployment. Results : The cross-lagged results showed physical symptoms at every time point were consistently related to greater PTSD symptoms at the subsequent time point. PTSD symptoms were related to subsequent physical symptoms, but only at one time-point with immediate post-deployment PTSD symptoms related to physical symptoms at three months after deployment. Conclusion : The findings extend prior work by providing evidence that PTSD and physical symptoms may be mutually maintaining even when there is not a severe traumatic physical injury.

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“…Recent studies highlighted the relationship between PTSD and physical symptoms (43,(69)(70)(71)(72). Subjects with both PTSD and chronic physical symptoms report a greater severity of the clinical picture (73,74), a worse prognosis (73,75), and a greater disability (76-78) than those with PTSD or physical symptoms only. McAndrew et al (79) suggested that there could be a bidirectional relationship; that is, increases in PTSD symptoms would predict later increases in physical symptoms, or increases in physical symptoms would predict later increases in PTSD symptoms.…”

Section: Discussionmentioning

confidence: 99%

Disrupted Rhythmicity and Vegetative Functions Relate to PTSD and Gender in Earthquake Survivors

et al. 2020

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Background: Increasing evidence indicates that survivors to traumatic events may show disruption of sleep pattern, eating and sexual behaviors, and somatic symptoms suggestive of alterations of biorhythmicity and vegetative functions. Therefore, the aim of this study was to investigate these possible alterations in a sample of survivors in the aftermath of earthquake exposure, with particular attention to gender differences and impact of post-traumatic stress disorder (PTSD). Methods: High school senior students, who had been exposed to the 2009 L'Aquila earthquake, were enrolled 21 months after the traumatic event and evaluated by the Trauma and Loss Spectrum Self-Report to investigate PTSD rates and by a domain of the Mood Spectrum Self-Report–Lifetime Version (MOODS-SR), to explore alterations in circadian/seasonal rhythms and vegetative functions. Results: The rates of endorsement of MOODS-SR rhythmicity and vegetative functions domain and subdomain scores were significantly higher in survivors with PTSD with respect to those without it. Among all earthquake survivors, women reported higher scores than men on the rhythmicity and vegetative functions domain and subdomain scores, except for the rhythmicity and sexual functions ones. Female survivors without PTSD showed significantly higher scores than men in the rhythmicity and vegetative functions total scores and the sleep and weight and appetite subdomains. Potentially traumatic events burden predicted rhythmicity and vegetative functions impairment, with a moderation effect of re-experiencing symptoms. Conclusions: We report impairments in rhythmicity, sleep, eating, and sexual and somatic health in survivors to a massive earthquake, particularly among subjects with PTSD and higher re-experiencing symptoms, with specific gender-related differences. Evaluating symptoms of impaired rhythmicity and vegetative functions seems essential for a more accurate assessment and clinical management of survivors to a mass trauma.

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Increased Pain Sensitivity in Accident-related Chronic Pain Patients With Comorbid Posttraumatic Stress

Abstract: The association between PTSD and pain intensity is in accordance with the mutual-maintenance and fear-avoidance models. Future studies should investigate changes in pain intensity and mechanisms after treatment targeting comorbid PTSD in chronic pain patients.

Cited by 33 publications

References 36 publications

Community-dwelling adults with a history of falling report lower perceived postural stability during a foam eyes closed test than non-fallers

Community-dwelling adults with a history of falling report lower perceived postural stability during a foam eyes closed test than non-fallers

Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment

Disrupted Rhythmicity and Vegetative Functions Relate to PTSD and Gender in Earthquake Survivors

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