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: 5.21). 06/2011; 152(10):2233-40. DOI: 10.1016/j.pain.2011.04.019
Source: PubMed


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.

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Available from: Bekh Bradley, Oct 07, 2015
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    • "Only general health was experienced as poorer in those with possible co-morbid PTSD compared to those without. Therefore, earlier findings using both civilian medical populations (Clapp et al., 2008; Phifer et al., 2011) and veterans (McFarlane et al., 1994; Shipherd et al., 2007) could not be confirmed in the present study. The negative findings may be due to the use of different population samples. "
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    ABSTRACT: BackgroundAlthough post-traumatic stress disorder (PTSD) is a common co-morbidity in chronic pain, little is known about the association between PTSD and pain in the context of chronic pain rehabilitation.ObjectiveThe aim of the present study was two-fold: (1) to investigate the association of a possible PTSD diagnosis with symptoms of pain, physical and mental functioning, as well as the use of opioids, and (2) to compare the outcome of multidisciplinary chronic pain rehabilitation for patients with a possible PTSD diagnosis at admission with patients without PTSD at admission.MethodA consecutively referred cohort of 194 patients completed a baseline questionnaire at admission covering post-traumatic stress, pain symptoms, physical and mental functioning, as well as self-reported sleep quality and cognitive difficulties. Medication use was calculated from their medical records. A total of 95 were admitted to further multidisciplinary treatment and included in the outcome study.ResultsA high prevalence of possible PTSD was found (26.3%). Patients with possible co-morbid PTSD experienced significantly poorer general and mental health, poorer sleep quality, and more cognitive problems as well as inferior social functioning compared to patients without PTSD. Possible co-morbid PTSD did not result in higher use of opioids or sedatives. Surprisingly, possible co-morbid PTSD at admission was not associated with lower levels of symptom reduction from pre- to post-treatment.ConclusionsPossible co-morbid PTSD in chronic pain is a major problem associated with significantly poorer functioning on several domains. Nevertheless, our results indicate that pain-related symptoms could be treated with success despite possible co-morbid PTSD. However, since PTSD was only measured at admission it is not known whether rehabilitation actually reduced PTSD.
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  • Pain 06/2011; 152(10):2196-7. DOI:10.1016/j.pain.2011.06.005 · 5.21 Impact Factor
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    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 · 1.66 Impact Factor
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