Veterans seeking treatment for posttraumatic stress disorder: What about comorbid chronic pain?

Abstract

Abstract-Our primary aim was to document the rate of comorbidity of physician-diagnosed chronic pain conditions in veterans who were seeking treatment for posttraumatic stress disorder (PTSD). Chronic pain diagnoses (e.g., chronic lowback pain and osteoarthritis) were examined with retrospective chart review. Of the patients with PTSD, 66% had chronic pain diagnoses at pretreatment. These findings are consistent with previous studies that documented the high comorbidity of chronic pain and PTSD using samples of pain patients. Our secondary aim was to examine pain ratings before, during, and after PTSD treatment. Using data that were a part of clinical practice, we found that patients with more pain before treatment reported reductions in pain over the course of PTSD treatment and in the 4 months following treatment. While our results must be interpreted cautiously because of multiple confounding factors and the absence of experimental manipulation, they highlight the importance of PTSD and pain comorbidity.

Pain experience of Iraq and Afghanistan Veterans with comorbid chronic pain and posttraumatic stress

“…The high rate of comorbidity between chronic pain and PTSD has been well documented [5,9,[42][43][44], and results from this study are consistent with these prior epidemiologic studies that have identified high prevalence rates of chronic pain and PTSD. Previous literature has demonstrated associations between PTSD and intensified pain severity, disability, and interference [45][46][47]; however, at least one study did not corroborate this finding [4].…”

“…Veterans who experience PTSD are likely to experience more intense and disabling pain, more maladaptive thought patterns, and more affective distress, and a provider may need to tailor pain treatment for the patient with comorbid PTSD. At least one study has suggested that treating PTSD may beneficially affect the experience of chronic pain [5]. This highlights the importance of assessing PTSD symptoms when treating Veterans with chronic pain.…”

“…In a recent study of Veterans receiving treatment for chronic pain, PTSD was identified in 49 percent of the sample [4]. Among Veterans seeking mental health treatment for PTSD, comorbid chronic pain was diagnosed in 66 percent of the patients studied [5]. The National Comorbidity Survey revealed that musculoskeletal pain was associated with a 400 percent increased risk of developing PTSD [6].…”

Preliminary analysis of posttraumatic stress disorder screening within specialty clinic setting for OIF/OEF veterans seeking care for neck or back pain

“…Finally, increased clinical awareness and screening efforts are likely identifying PTSD symptoms among OIF/OEF veterans that might have gone undetected in veterans from previous conflicts. Studies have demonstrated both high levels of PTSD symptom severity among patients with chronic pain [54] and high rates of chronic pain among patients with PTSD [16][17]55]. PTSD symptom severity has been associated with poorer health functioning among OIF/OEF veterans [56][57].…”

“…Mounting evidence exists within the scientific literature regarding the co-occurrence of and the relationship between PTSD and chronic pain [11][12][13][14][15][16][17][18]. Otis et al has published a comprehensive summary of theoretical models, including mutual maintenance and shared vulnerability, underlying comorbid chronic pain and PTSD [14].…”