The relationship between PTSD and chronic pain: Mediating role of coping strategies and depression

Abstract

People with chronic pain and comorbid posttraumatic stress disorder (PTSD) report more severe pain and poorer quality of life than those with chronic pain alone. This study evaluated the extent to which associations between PTSD and chronic pain interference and severity are mediated by pain-related coping strategies and depressive symptoms. Veterans with chronic pain were divided into two groups, those with (n=65) and those without (n=136) concurrent PTSD. All participants completed measures of pain severity, interference, emotional functioning, and coping strategies. Those with current PTSD reported significantly greater pain severity and pain interference, had more symptoms of depression, and were more likely to meet diagnostic criteria for a current alcohol or substance use disorder (all p-values ≤ 0.01). Participants with PTSD reported more use of several coping strategies, including guarding, resting, relaxation, exercise/stretching, and coping self-statements. Illness-focused pain coping (i.e., guarding, resting, and asking for assistance) and depressive symptoms jointly mediated the relationship between PTSD and both pain interference (total indirect effect = 0.194, p < 0.001) and pain severity (total indirect effect = 0.153, p = 0.004). Illness-focused pain coping also evidenced specific mediating effects, independent of depression. In summary, specific pain coping strategies and depressive symptoms partially mediated the relationship between PTSD and both pain interference and severity. Future research should examine whether changes in types of coping strategies following targeted treatments predict improvements in pain-related function for chronic pain patients with concurrent PTSD.

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

“…First, we compare traumatically-exposed adults with and without PTSD on measures of psychological flexibility, pain severity, pain interference, and depression in a sample seeking treatment for chronic pain. In line with earlier research [6,18], are first reversed) to arrive at a total score (range = 0-108), where higher scores represent greater levels of committed action. The original English version (α =.91) and the Swedish version (α = .89) used in this study have satisfactory internal consistency and validity [41,42].…”

“…Various models have been applied to explain the relationship between PTSD and chronic pain [18][19][20][21], but up until now no studies that we are aware of have investigated whether processes from the psychological flexibility model mediate this relationship. The results from this study suggest that several processes from this model may contribute to the negative interaction between PTSD and chronic pain.…”

“…Mediation models should be chosen through assumptions that are either invoked based on theory or fulfilled by design features [56]. In accordance with this, our mediation models were based on earlier longitudinal research, which has highlighted the long term impact of PTSD symptoms on pain intensity [14] and has identified mechanisms that mediate the effect of PTSD symptoms on pain intensity [15], and cross-sectional research, which has investigated mediators of the relationship between PTSD and chronic pain [18][19][20][21]. The mediation models were also strengthened by the current data, which showed that the trauma producing the current PTSD symptoms happened on average 3-5 years prior to the time that the measures of pain and psychological flexibility were administered.…”

“…Mediation analyses using PTSD symptom severity and the PTSD symptom clusters as the independent variables were conducted and comparable levels of variance were explained with consistent result patterns. However, using diagnostic status as the independent variable is in line with similar research [18] and such an approach is preferable over the other available measures since it incorporates not only a wide range of symptoms from all PTSD clusters but also the impact on overall functioning, and only these analyses were retained in the manuscript.…”

“…There is a growing body of evidence from such studies where elevated levels of depression, anxiety, maladaptive coping, alcohol use, and negative trauma-related cognitions have been identified as mediators of the relationship between PTSD and chronic pain [18][19][20][21]. Still, clear theoretically-based, psychological dimensions that might underline these variables remain to be identified [14].…”