The Relationship Between Posttraumatic Stress Disorder and Chronic Pain in People Seeking Treatment for Chronic Pain

Abstract

Objectives: The symptoms of Posttraumatic Stress Disorder (PTSD) and chronic pain are thought to interact to increase the severity and impact of both conditions, but the mechanisms by which they interact remain unclear. This study examines the relationship between PTSD and chronic pain and whether indices of psychological flexibility mediate the relationship between these two conditions.Methods: Standardized self-report measures of PTSD, pain severity, pain interference, depression, and psychological flexibility (pain-related acceptance, committed action, cognitive fusion, and values-based action) were obtained from 315 people seeking treatment for chronic pain who also reported at least one traumatic experience.Results: People seeking treatment for chronic pain reporting symptoms consistent with a current diagnosis of PTSD had significantly higher levels of pain severity, pain interference, depression, and cognitive fusion and lower levels of pain-related acceptance and committed action than those reporting symptoms below diagnostic threshold for PTSD. Pain-related acceptance, committed action, cognitive fusion and depression mediated the relationship between PTSD and pain severity/interference, with pain-related acceptance being the strongest mediator from the psychological flexibility model.

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

“…Psychological flexibility has been described as a fundamental aspect of human health, involving the capacity to shift one's mindset and behaviours, in concert with one's values, to adapt to varying situational demands, including symptoms of various medical and psychiatric conditions (Kashdan & Rottenberg, ). As noted in the introduction, in previous studies, we found that the relationship between PTSD and pain at pre‐treatment was mediated by psychological flexibility, and that pain‐related outcomes in CBT for chronic pain were mediated by changes in acceptance of pain (Åkerblom et al, , ).…”

“…In a previous study, we found that changes in psychological flexibility as indexed by pain acceptance, as well as changes in life control, mediated changes in treatment outcomes in individuals undergoing CBT for chronic pain at a specialist pain clinic (Åkerblom, Perrin, Rivano Fischer, & McCracken, ). In a separate study from the same pain clinic, we found that processes from the psychological flexibility model (pain acceptance, committed action, cognitive fusion) mediated the relationship between PTSD and pain‐related functioning at pre‐treatment (Åkerblom, Perrin, Rivano Fischer, & McCracken, ). These results raise the possibility that if participation in a CBT program for chronic pain also yields reductions in comorbid conditions like PTSD, depression and anxiety, these may be associated with increases in psychological flexibility or related processes.…”

“…Following recommendations in the literature for research examining the relationship between PTSD and pain (Asmundson & Katz, 2009), we also include depression and anxiety as predictors alongside PTSD and follow these symptoms during treatment, given the symptom overlap and the high rates of these conditions in chronic pain samples. Third, we assess whether any observed changes in PTSD are mediated by changes in three psychological mechanisms (psychological inflexibility, life control and kinesiophobia) that have been shown to be of importance to both PTSD and chronic pain (Åkerblom et al, 2018;Palyo & Beck, 2005;Russek et al, 2015;Turner et al, 2007;Vlaeyen & Linton, 2000).…”

Painful memories: Challenges in trauma-focused therapy for torture survivors with PTSD and chronic pain

“…Furthermore, catastrophizing and kinesiophobia have been found to predict pain-related disability (Guimarra et al, 2017), and PTSD is a more potent risk factor for developing pain than the experience of trauma in itself (Jenewein et al, 2009;Ciccone et al, 2005). Painrelated avoidance, fear-avoidance and pain catastrophizing have been found to mediate the relationship between chronic pain and PTSD (Åkerblom et al, 2018;Andersen et al, 2016). Moreover, Siqveland et al (2017) found that chronic pain was mediated by PTSD and whether the trauma was inten-tional.…”

Influência do gênero no limiar de dor em idosos segundo presença de dor crônica

“…A dor, em geral, pode causar depressão e os sintomas de dor crônica podem ser agravados por sua presença 95 . Fatores como percepção de controle da dor, sentimento de incapacidade em lidar com a dor, incapacidade funcional, comprometimento cognitivo e tabagismo são preditores da depressão em idosos 96 .…”