Abstract

It is unclear how to address PTSD in the context of chronic pain management. Here we examine the potential benefits of an addition of prolonged exposure (PE) therapy for PTSD for adults attending multidisciplinary CBT for chronic pain. Four adults seeking treatment for chronic pain from a specialized pain rehabilitation service were offered PE for PTSD using a replicated, randomized, single-case experimental phase design, prior to commencing a 5-week multidisciplinary CBT program for chronic pain. Pre-, post-, follow-up, and daily measures allowed examination of PTSD and pain outcomes, potential mediators, and the trajectory of these outcomes and potential mediators during the subsequent pain-focused CBT program. Visual inspection of the daily data demonstrated changes in all outcome variables and potential mediators during the PE phase. Changes came at different times andat different rates for the four participants, highlighting the individual nature of putative change mechanisms. Consistent with expectation, PE produced reliable change in the severity of PTSD symptoms and trauma-related beliefs for all four participants, either by the end of the PE phase or the PE follow-up, with these gains maintained by the end of the 5-week pain-focused CBT program. However, few reductions in pain intensity or pain interference were seen either during the PE phase or after. Although "disorder specific" approaches have dominated the conceptualising, study, and treatment of conditions like PTSD and chronic pain, such approaches may not be optimal. It may be better instead to approach cases in an individual and process-focused fashion. 2013/381.

Highlights

  • In comparison to the general population, individuals seeking treatment for chronic pain are at significantly increased risk of comorbid mental health conditions [1]

  • We hypothesized that prolonged exposure (PE) would decrease Posttraumatic Stress Disorder (PTSD) symptoms compared to the no treatment phase, and this decline in would be associated with improvements in un-targeted symptoms of pain intensity and interference during the PTSD-focused treatment

  • We hypothesized that PE would decrease PTSD symptoms compared to the no treatment phase, and this decrease would be associated with improvements in un-targeted symptoms of pain during the PTSD-focused treatment

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Summary

Introduction

In comparison to the general population, individuals seeking treatment for chronic pain are at significantly increased risk of comorbid mental health conditions [1]. Among the most common comorbid conditions is Posttraumatic Stress Disorder (PTSD), where the self-reported prevalence is estimated at 20.5%, nearly four times higher than the general population [2, 3]. Similar experiences and psychological processes involved in PTSD and chronic pain may create a situation where they mutually exacerbate or maintain each other [3, 5,6,7,8]. The most widely disseminated evidence-based treatment for chronic pain is cognitive behavioral therapy (CBT) [9]. CBT for chronic pain typically does not include the core (active) components in all evidence-based treatments for PTSD, namely a combination of therapist and

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