Pain perception and processing in individuals with posttraumatic stress disorder: a systematic review with meta-analysis

Tesarz, Jonas; Baumeister, David; Andersen, Tonny Elmose; Vægter, Henrik Bjarke

doi:10.1097/pr9.0000000000000849

Cited by 16 publications

(18 citation statements)

References 50 publications

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“…Pain and trauma are highly comorbid conditions ( 1 – 6 ), especially among the military and veteran population ( 7 , 8 ), and both are associated with dramatic changes in the brain structure and function ( 9 , 10 ). Using experimental pain and task-based functional magnetic resonance imaging (fMRI), we and others have repeatedly shown that men and women with trauma demonstrate dysregulated behavioral ( 11 , 12 ) and brain response to pain, depicted in the increased pain avoidance and dysregulated modulatory response within interoceptive, reward, and frontal modulatory networks ( 13 – 17 ).…”

Section: Introductionmentioning

confidence: 99%

Understanding Pain and Trauma Symptoms in Veterans From Resting-State Connectivity: Unsupervised Modeling

Strigo

Spadoni²,

Simmons³

2022

Front. Pain Res.

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Trauma and posttraumatic stress are highly comorbid with chronic pain and are often antecedents to developing chronic pain conditions. Pain and trauma are associated with greater utilization of medical services, greater use of psychiatric medication, and increased total cost of treatment. Despite the high overlap in the clinic, the neural mechanisms of pain and trauma are often studied separately. In this study, resting-state functional magnetic resonance imaging (rs-fMRI) scans were completed among a diagnostically heterogeneous sample of veterans with a range of back pain and trauma symptoms. Using Group Iterative Multiple Model Estimation (GIMME), an effective functional connectivity analysis, we explored an unsupervised model deriving subgroups based on path similarity in a priori defined regions of interest (ROIs) from brain regions implicated in the experience of pain and trauma. Three subgroups were identified by patterns in functional connection and differed significantly on several psychological measures despite similar demographic and diagnostic characteristics. The first subgroup was highly connected overall, was characterized by functional connectivity from the nucleus accumbens (NAc), the anterior cingulate cortex (ACC), and the posterior cingulate cortex (PCC) to the insula and scored low on pain and trauma symptoms. The second subgroup did not significantly differ from the first subgroup on pain and trauma measures but was characterized by functional connectivity from the ACC and NAc to the thalamus and from ACC to PCC. The third subgroup was characterized by functional connectivity from the thalamus and PCC to NAc and scored high on pain and trauma symptoms. Our results suggest that, despite demographic and diagnostic similarities, there may be neurobiologically dissociable biotypes with different mechanisms for managing pain and trauma. These findings may have implications for the determination of appropriate biotype-specific interventions that target these neurological systems.

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Section: Introductionmentioning

confidence: 99%

Understanding Pain and Trauma Symptoms in Veterans From Resting-State Connectivity: Unsupervised Modeling

Strigo

Spadoni²,

Simmons³

2022

Front. Pain Res.

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“…A recent meta-analysis of pain processing and perception in healthy adults revealed no significant differences in pain intensity ratings or pain tolerance in individuals with vs without PTSS. 43 However, when they stratified their sample by individuals with combat-related trauma and accident-related trauma, they found significantly increased and decreased thresholds for pain, respectively. 43 Therefore, youth with higher PTSS and chronic pain appear to be more similar to adults that have experienced combat-related trauma in their responses to the CPT.…”

Section: Discussionmentioning

confidence: 97%

“… 43 However, when they stratified their sample by individuals with combat-related trauma and accident-related trauma, they found significantly increased and decreased thresholds for pain, respectively. 43 Therefore, youth with higher PTSS and chronic pain appear to be more similar to adults that have experienced combat-related trauma in their responses to the CPT. The frontal cerebral cortex is the area of the brain that governs rational thought.…”

Section: Discussionmentioning

confidence: 97%

“…A recent meta-analysis of the adult literature found that combat-related PTSD was associated with increased pain thresholds, whereas accident-related PTSD was associated with decreased pain thresholds. 43 However, the relationships between PTSS and pain sensitization in youth with chronic pain remains unknown. In the present study, we examined the relationships between PTSS, state pain catastrophizing, pain intensity, and pain thresholds in youth with chronic pain.…”

Section: Introductionmentioning

confidence: 99%

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Trauma and pain sensitization in youth with chronic pain

Janssen

Abou-Assaly

Rasic

et al. 2022

PR9

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“…Independent research into the opioid dysregulation schema of patients suffering from both conditions reveal portentous underpinnings of decreased pain thresholds and reduced endogenous opioid levels 4 . When compared to age‐matched cohorts without PTSD, those with the disorder retain significantly higher risks of developing subsequent dependence after initial exposure to opioid analgesia 5,6 . The higher risk of opioid use disorder for these patients is due to the shared vulnerability model, the mutual maintenance model whereby trauma and stress worsen pain and vice versa, and the fact that opioids may not only relieve physical pain but also relieve some of the disabling PTSD symptoms through effects on the hypothalamic‐pituitary‐adrenal (HPA) axis 3 .…”

Section: Introductionmentioning

confidence: 99%

Impact of an opioid prescribing alert system on patients with posttraumatic stress disorder

et al. 2022

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Background and Objectives Posttraumatic stress disorder (PTSD) is associated with higher rates of chronic pain and increased risk of developing Opioid use disorder. This paper evaluates the impact of PRIMUM, an electronic health record‐embedded (EHR) clinical decision support intervention on opioid prescribing patterns for patients with diagnosis of PTSD. Methods Inpatient, emergency department (ED), urgent care, and outpatient encounters with ICD‐10 codes F43.1 (PTSD), F43.10 (PTSD, unspecified), F43.11 (PTSD, acute), and F43.12 (PTSD, chronic) at Atrium Health between 1/1/2016 and 12/29/2018 were included in the study. Results A total of 3121 patients with a diagnosis of PTSD were seen in 37,443 encounters during the study period. Ten percent (n = 3761) of the encounters resulted in prescriptions for opioids and PRIMUM alerts were triggered in 1488 of these encounters. These alerts resulted in “decision influenced” for 17% of patients (n = 255) or no prescriptions for opioids or benzodiazepines for 5.8% (n = 86). The majority of the prescriptions were below 50 Morphine milligram equivalents (MME)/day, but there were 570 (15.5%) prescriptions for doses of 50–90 MME and 721 (19.6%) prescriptions for >90 MME/day. Discussion and Conclusion The PRIMUM alert system helps improve patient safety. PRIMUM affected clinician decisions 17% of the time, and the effect was greater in patients with opioid overdose history and those presenting for early refills. Scientific Significance The effectiveness of clinical support interventions for opioid prescribing for patients with PTSD has not been documented previously. Our findings provide novel evidence that the EHR can be used to improve patient safety among patients with PTSD in the context of substance use.

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Pain perception and processing in individuals with posttraumatic stress disorder: a systematic review with meta-analysis

Abstract: Supplemental Digital Content is Available in the Text. Posttraumatic stress disorder encompasses latent subgroups of individuals with qualitative differences in pain perception.

Cited by 16 publications

References 50 publications

Understanding Pain and Trauma Symptoms in Veterans From Resting-State Connectivity: Unsupervised Modeling

Understanding Pain and Trauma Symptoms in Veterans From Resting-State Connectivity: Unsupervised Modeling

Trauma and pain sensitization in youth with chronic pain

Impact of an opioid prescribing alert system on patients with posttraumatic stress disorder

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