Article

Pain symptomatology and pain medication use in civilian PTSD

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30303, USA.
Pain (Impact Factor: 5.84). 06/2011; 152(10):2233-40. DOI: 10.1016/j.pain.2011.04.019
Source: PubMed

ABSTRACT The comorbidity of pain syndromes and trauma-related syndromes has been shown to be high. However, there have been limited data, especially in civilian medical populations, on the role of trauma-related disorders such as posttraumatic stress disorder (PTSD) on chronic pain and pain medication use. We analyzed 647 general hospital patients in primary care and obstetrics and gynecological waiting rooms for the experience of trauma and PTSD-related stress disorders. PTSD symptoms were found to be significantly positively correlated with pain ratings (r=.282, P<0.001) and pain-related functional impairment (r=0.303, P<0.001). Those with a current PTSD diagnosis had significantly higher subjective pain and pain-related impairment ratings than those with no PTSD. Furthermore, those with a current diagnosis of PTSD were significantly more likely to have used opioid analgesics for pain control compared to those without a diagnosis of PTSD (χ(2)=8.98, P=0.011). When analyzing the separate PTSD symptom subclusters (re-experiencing, avoidance, and hyperarousal), all symptom clusters were significantly related to pain and pain-related impairment ratings, but only the avoidance cluster was significantly related to prior opioid pain medication use. We conclude that PTSD and trauma-related disorders are common in impoverished medical populations and that their presence should be examined in patients with pain syndromes. Furthermore, these data suggest that PTSD and pain may share a vulnerability pathway, including the endogenous opioid neurotransmission systems.

Download full-text

Full-text

Available from: Bekh Bradley, Aug 16, 2015
0 Followers
 · 
123 Views
  • Pain 06/2011; 152(10):2196-7. DOI:10.1016/j.pain.2011.06.005 · 5.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this review is to look at the options available for the management of pain in victims of conflict, from the point of wounding, through a chain of evacuation, to rehabilitation in the home country. This is relevant for all healthcare workers as any could find themselves treating veterans and having a clear understanding of what occurred will help. The article will discuss developments in the prehospital environment, the field hospital, during repatriation and back in the home country to include neurostimulation in cases of refractory pain. Evidence when available is provided and the difficulties in conducting research in this environment are touched upon. The current agents, routes and techniques found in any civilian medical service can be brought to bear with great benefit. However, the secret appears to lie in a robust approach to the importance of treating pain, encouraged in all healthcare professionals, and the recognition of the role of integrating the healthcare package throughout the chain of evacuation. Research remains difficult.
    Current opinion in supportive and palliative care 03/2012; 6(2):172-6. DOI:10.1097/SPC.0b013e3283520fa0
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Record numbers of Iraq and Afghanistan veterans survive their war injuries and yet continue to experience pain and mental health problems, particularly posttraumatic stress disorder (PTSD). Little is known about the association of mental health disorders and prescription opioid use. To investigate the effect of mental health disorders, particularly PTSD, on risks and adverse clinical outcomes associated with prescription opioid use. Retrospective cohort study involving 141,029 Iraq and Afghanistan veterans who received at least 1 non-cancer-related pain diagnosis within 1 year of entering the Department of Veterans Affairs (VA) health care system from October 1, 2005, through December 31, 2010. Independent association of mental health disorders and the prescription of opioids, higher risk opioid use, and adverse clinical outcomes (eg, accidents and overdose) within 1 year of receiving a pain-related diagnosis. A total of 15,676 veterans were prescribed opioids within 1 year of their initial pain diagnosis. Compared with 6.5% of veterans without mental health disorders, 17.8% (adjusted relative risk [RR], 2.58; 95% CI, 2.49-2.67) of veterans with PTSD and 11.7% (adjusted RR, 1.74; 95% CI, 1.67-1.82) with other mental health diagnoses but without PTSD were significantly more likely to receive opioids for pain diagnoses. Of those who were prescribed pain medication, veterans with PTSD were more likely than those without mental health disorders to receive higher-dose opioids (22.7% vs 15.9%, adjusted RR, 1.42; 95% CI, 1.31-1.54), receive 2 or more opioids concurrently (19.8% vs 10.7%, adjusted RR, 1.87; 95% CI, 1.70-2.06), receive sedative hypnotics concurrently (40.7% vs 7.6%, adjusted RR, 5.46; 95% CI, 4.91-6.07), or obtain early opioid refills (33.8% vs 20.4%; adjusted RR, 1.64; 95% CI, 1.53-1.75). Receiving prescription opioids (vs not) was associated with an increased risk of adverse clinical outcomes for all veterans (9.5% vs 4.1%; RR, 2.33; 95% CI, 2.20-2.46), which was most pronounced in veterans with PTSD. Among US veterans of Iraq and Afghanistan, mental health diagnoses, especially PTSD, were associated with an increased risk of receiving opioids for pain, high-risk opioid use, and adverse clinical outcomes.
    JAMA The Journal of the American Medical Association 03/2012; 307(9):940-7. DOI:10.1001/jama.2012.234 · 30.39 Impact Factor
Show more