Abstract

IntroductionComorbid posttraumatic stress disorder (PTSD) in patients with chronic pain may have a negative effect on the course and outcome of both disorders. Nevertheless, the co-occurrence of the two conditions is often overlooked in clinical settings. Further, little is known about how PTSD is associated with biopsychosocial characteristics in this patient group. The first objective was to assess the prevalence of posttraumatic stress symptoms (PTSS) in patients with chronic pain in a Norwegian university hospital outpatient pain clinic. The second objective was to investigate possible associations between PTSS and adverse outcomes such as pain intensity, disability, and distress. The third objective was to compare the PTSS prevalence rates between primary versus secondary pain conditions.Materials and methodsSix hundred and ninety-two patients meeting for pain assessment completed self-report questionnaires about PTSS and possibly associated factors. The Life Events Checklist and the Stressful Life Events Screening Questionnaire were used to screen for potentially traumatic life events. The Impact of Events Scale – Revised and the PTSD Checklist for DSM-5 were used to assess PTSS. Differences between patients with and without severe PTSS on the possibly associated variables were analyzed by chi-squared-, and t-tests.Results20.7% of the participants reported a level of PTSS qualifying for a PTSD diagnosis. These patients reported higher levels of pain intensity, pain bothersomeness, disability, and psychological distress, as well as lower levels of self-efficacy. They also reported higher levels of pain catastrophizing, perceived injustice, fatigue, and sleep difficulties. Finally, there was not a significant difference in prevalence rates between primary and secondary pain conditions.DiscussionPTSS are frequent in patients with chronic pain, and a range of psychological characteristics is associated with a high level of such symptoms in this patient group. Patients with both conditions report a significantly higher symptom load, and the potential impact on the individual’s life is major. In terms of pain condition, there were no differences in PTSS between primary pain conditions and secondary pain conditions in this pain population. This study emphasizes the importance of increased attention on PTSS when seeing patients with chronic pain conditions in clinical practice.

Highlights

  • Comorbid posttraumatic stress disorder (PTSD) in patients with chronic pain may have a negative effect on the course and outcome of both disorders

  • PTSD is classified as a stressrelated disorder in DSM-5 (American Psychiatric Association, 2013), and the condition may develop after exposure to actual or threatened death, serious injury, or sexual violence

  • The condition is associated with an increased risk of psychological and physical health problems, and individuals suffering from PTSD often display high levels of physical, occupational, and social disability (American Psychiatric Association, 2013)

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Summary

Introduction

Comorbid posttraumatic stress disorder (PTSD) in patients with chronic pain may have a negative effect on the course and outcome of both disorders. The first objective was to assess the prevalence of posttraumatic stress symptoms (PTSS) in patients with chronic pain in a Norwegian university hospital outpatient pain clinic. The importance of comorbid physical and psychological disorders in patients with chronic pain conditions has been emphasized in the last half-century, as the understanding of pain as a multidimensional experience has developed. A relationship between psychiatric disorders such as depression and anxiety and chronic pain was early suggested (Banks and Kerns, 1996; Asmundson et al, 1996), while in the later years the association between chronic pain and posttraumatic stress disorder (PTSD) has gained increased attention. Pain is among the physical symptoms most frequently reported by individuals with PTSD, and it is found independent of the nature of the trauma (Asmundson et al, 2002)

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