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Comorbid Chronic Pain and PTSD: An Update on Research and Treatment

0 2 years ago

The prevalence rate of chronic pain in the general US population ranges between 10% to 20%.¹ Chronic pain has been found to commonly coexist with post-traumatic stress disorder (PTSD) symptoms. In the veteran population, the prevalence of PTSD has been found to be between 10% to 47% among those referred to a pain clinic²˒³ or attending a multidisciplinary chronic pain center.⁴ Patients with comorbid chronic pain and PTSD have been found to endorse more negative belief-based and behavioral symptoms compared to patients with chronic pain only.³˒⁵ They have also been found to be at greater risk for negative coping, such as with substance use.⁵

Together, these findings support the need for tailored treatment interventions for patients with comorbid chronic pain and PTSD. Consequentially, theory-supported treatment programs have evolved overtime to meet the unique needs of patients who suffer from this type of comorbidity.

Post-Traumatic Stress Disorder Defined

To understand the best treatment practices applied to comorbid chronic pain and PTSD, the utilization of the proper assessment of PTSD is crucial. The definition of PTSD has broadened since the release of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013.⁶ The diagnosis now includes traumatic events that were experienced directly, indirectly, witnessed by the individual, or experienced by a family member or friend.⁶ In addition to these experiences, the individual must also exhibit symptoms from four different clusters of symptoms:

  • reexperiencing
  • arousal
  • avoidance
  • persistent negative alterations in cognitions and mood

PTSD can be diagnosed accurately by a trained mental health professional. The gold standard assessment is the Clinician Administered PTSD Scale for the DSM-5 (CAPS-5), which employs an interview with the patient about trauma and PTSD symptoms. PTSD has been found to affect 10% of women and 5% of men at some stage.⁷ However, the prevalence rates of PTSD in victims of trauma have been purported to approach 100%.⁸

Physical health problems (cardiovascular, headaches, diabetes, respiratory, gastrointestinal, and musculoskeletal) have been shown to be more common among individuals suffering from PTSD.⁹ Studies examining the prevalence of chronic pain in individuals with a primary diagnosis of PTSD have reported even higher co-prevalence rates. The rate of chronic pain in patients who suffer from PTSD is approximately double that of the general population.⁹ Pain is the most common physical complaint among patients who suffer from PTSD.¹⁰ Research has shown that anywhere from 60% to 80% of veterans with PTSD report that they have a chronic pain condition.¹¹˒¹²

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