Post-traumatic Pain Research Articles

Stepped collaborative care for pain and posttraumatic stress disorder after major trauma: a randomized controlled feasibility trial

Purpose To examine feasibility and acceptability of providing stepped collaborative care case management targeting posttraumatic stress disorder (PTSD) and pain symptoms after major traumatic injury. Materials and methods Participants were major trauma survivors in Victoria, Australia, at risk of persistent pain or PTSD with high baseline symptoms. Participants were block-randomized, stratified by compensation-status, to the usual care (n = 15) or intervention (n = 17) group (46% of eligible patients). The intervention was adapted from existing stepped collaborative care interventions with input from interdisciplinary experts and people with lived experience in trauma and disability. The proactive case management intervention targeted PTSD and pain management for 6-months using motivational interviewing, cognitive behavioral therapy strategies, and collaborative care. Qualitative interviews explored intervention acceptability. Results Intervention participants received a median of 7 h case manager contact and reported that they valued the supportive and non-judgmental listening, and timely access to effective strategies, resources, and treatments post-injury from the case manager. Participants reported few disadvantages from participation, and positive impacts on symptoms and recovery outcomes consistent with the reduction in PTSD and pain symptoms measured at 1-, 3- and 6-months. Conclusions Stepped collaborative care was low-cost, feasible, and acceptable to people at risk of PTSD or pain after major trauma. IMPLICATIONS FOR REHABILITATION After hospitalization for injury, people can experience difficulty accessing timely support to manage posttraumatic stress, pain and other concerns. Stepped case management-based interventions that provide individualized support and collaborative care have reduced posttraumatic stress symptom severity for patients admitted to American trauma centers. We showed that this model of care could be adapted to target pain and mental health in the trauma system in Victoria, Australia. The intervention was low cost, acceptable and highly valued by most participants who perceived that it helped them use strategies to better manage post-traumatic symptoms, and to access clinicians and treatments relevant to their needs.

Does Immediate Long-Span Nerve Allograft Reconstruction Affect the Incidence of Chronic Postsurgical and Neuropathic Pain in the Reconstructed Mandible Following Resection for Benign and Malignant Disease

Peripheral nerve injury can lead to chronic postsurgical pain (CPSP) and neuropathic pain following major surgery. Determine in patients undergoing ablative mandibular operations with transection of the trigeminal nerve: do those who undergo immediate repair, when compared to those whose nerves are not repaired, have a decreased or increased risk for CPSP or post-traumatic trigeminal neuropathic pain (PTTNp)? A multisite, retrospective cohort of patients who underwent resection of the mandible for benign or malignant disease with either no repair or immediate repair of the intentionally transected trigeminal nerve with a long-span nerve allograft were analyzed for the presence or absence of CPSP and PTTNp at 6months. The primary predictor was the immediate repair or no repair of the trigeminal nerve. The primary outcome was the presence or absence of CPSP and PTTNp at 6months postsurgery. There were 13 covariate variables, including age, sex, ethnicity, nerve injury, type of PTTNp, malignant or benign pathology and subtypes of each, use of radiation or chemotherapy, treatment of transected nerve end, longest follow-up time, pain scale, and onset of pain. Two-tailed Student's t test and Welch's t test were performed on mean scores and post hoc logistics and linear regression modeling were performed when indicated. The confidence level for statistical significance was P value <.05. There were 103 and 94 subjects in the immediate and no-repair groups, respectively. The incidence of CPSP in the no-repair group was 22.3% and PTTNp was 2.12%, while there was 3.8% CPSP and 0% PTTNp in the repair group, which was statistically significant (P= <.001). Logistic regression modeling showed a statistically significant inverse relationship between the immediate repair and the incidence of CPSP/PTTNp with an odds ratio of 0.43, 95% confidence interval 0.18 to 1.01, P=.05. Greater age, malignant pathology, and chemo/radiation treatments were covariates found more frequently in the no repair group. Immediate repair of an intentionally transected trigeminal nerve with a long-span nerve allograft during resection of the mandible for both benign and malignant disease appears to reduce CPSP and possibly eliminate the development of PTTNp.

Temperature-sensitive multifunctional intelligent responsive hydrogel based on carboxymethyl agarose and N-isopropylacrylamide: Controlled drug release and accelerated wound healing

Wound healing remains challenging due to posttraumatic pain. At present, most wound dressings ignore the importance of wound pain. In this study, a temperature-sensitive multifunctional intelligent hydrogel patch (CPAG) containing lidocaine has developed for wound healing. CPAG hydrogel was prepared by grafting N-isopropylacrylamide and acrylamide onto carboxymethyl agarose (CMA) modified by agarose and encapsulating gallic acid and lidocaine. FTIR, 1H NMR spectroscopy, SEM and rheology were used to investigate its structure and temperature-sensitive properties. The contraction force generated by the temperature response characteristics of CPAG at 30 °C can accelerate wound healing. In vitro release assays demonstrated that CPAG directly controlled the same amount of lidocaine release at different temperatures through the competition between polymer-polymer and polymer-water interactions. In addition, MTT, H&E staining and stimulation test further proved its biological safety. The pain behavior study showed that the pain inhibition rates of the lidocaine cataplasms and LID@CPAG were 51.16 % and 67.83 %, respectively. In vitro and in vivo studies have shown that compared with the blank group, the bleeding volume of LID@CPAG decreased by 54.3 %, and the wound healing rate reached 97 %. CPAG hydrogel can play a comprehensive therapeutic role in accelerating wound closure by controlling drug release, analgesia, antioxidation and hemostasis.

Associations Between Postpartum Pain Type, Pain Intensity and Opioid Use in Patients With and Without Opioid Use Disorder: A Cross-sectional Study

(British Journal of Anaesthesia. 2023;130:94e102) Pain is a sensory, cognitive, and emotional experience and is affected by a number of biological, psychological, and social factors. Postpartum pain assessment and management remain limited to a one-size-fits-all approach, despite the wide range of pain experiences and types. Patients with opioid use disorder (OUD) may have more complex pain experiences and are at increased risk of severe post-traumatic pain, postoperative complications, readmission, and overdose than those without OUD. The over-prescribing of opioids for postpartum pain management is mitigated by recent efforts to promote shared-decision making. However, overly conservative prescribing practices or poorly managed pain can lead to negative outcomes. This study aimed to investigate the associations between pain type, pain intensity and opioid use during hospital stay, and examine the way pain type influences pain intensity and opioid use among people with and without OUD.

Parenteral Ready-to-Use Fixed-Dose Combinations Including NSAIDs with Paracetamol or Metamizole for Multimodal Analgesia-Approved Products and Challenges.

The combination of non-steroidal anti-inflammatory drugs (NSAIDs) with non-opioid analgesics is common in clinical practice for the treatment of acute painful conditions like post-operative and post-traumatic pain. Despite the satisfactory results achieved by oral analgesics, parenteral analgesia remains a key tool in the treatment of painful conditions when the enteral routes of administration are inconvenient. Parenteral ready-to-use fixed-dose combinations of non-opioid analgesics combinations, including NSAIDs and paracetamol or metamizole, could play a central role in the treatment of painful conditions by combining the advantages of multimodal and parenteral analgesia in a single formulation. Surprisingly, only in 2020, a parenteral ready-to-use fixed-dose combination of ibuprofen/paracetamol was launched to the market. This review aims to investigate the current availability of combinations of NSAIDs with paracetamol or metamizole in both European and American markets, and how the combination of such drugs could play a central role in a multimodal analgesia strategy. Also, we explored how the parenteral formulations of NSAIDs, paracetamol, and metamizole could serve as starting elements for the development of new parenteral ready-to-use fixed-dose combinations. We concluded that, despite the well-recognized utility of combining NSAIDs with paracetamol or metamizole, several randomized clinical trial studies demonstrate no clear advantages concerning their efficacy and safety. Future clinical trials specifically designed to assess the efficacy and safety of pre-formulated fixed-dose combinations are required to generate solid evidence about their clinical advantages.

The Use of Microcurrent Therapy in the Treatment of Cases Suffering from Post-Traumatic Trigeminal Neuropathic Pain Secondary to Iatrogenic Dental Treatment

The Use of Microcurrent Therapy in the Treatment of Cases Suffering from Post-Traumatic Trigeminal Neuropathic Pain Secondary to Iatrogenic Dental Treatment

Time doesn't heal all: PTSD symptoms exacerbate the relationship between age and pain intensity.

Posttraumatic stress disorder (PTSD) symptoms and pain interfere with daily functioning and quality of life for many combat Veterans. As individuals age, pain symptoms tend to increase whereas PTSD symptoms tend to decrease. PTSD symptoms exacerbate pain, but the nature of this relationship across the aging process is unclear. The purpose of this study was to determine how PTSD symptoms affect the association between age and pain intensity. Participants in this cross-sectional study included 450 Veterans (80% male) who served after September 11, 2001. PTSD and pain intensity ratings were assessed by the PTSD Checklist for DSM-5 (PCL-5) and the Brief Pain Inventory (BPI), respectively. Hierarchical multiple linear regression evaluated main and interaction effects between age, PTSD symptoms, and pain intensity. Age (B = 0.04, p < 0.001) and PTSD symptoms (B = 0.05, p < 0.001) were positively associated with pain intensity. Age and PTSD symptoms were inversely correlated (r = -0.16, p < 0.001). PTSD symptoms exacerbated the relationship between age and pain intensity (ΔR2 = 0.01, p = 0.036). Specifically, when greater PTSD symptoms were reported at older ages, pain intensity was significantly higher. Results of these analyses suggests that age is important when considering the effects of PTSD symptoms on pain intensity ratings. Specifically, pain intensity ratings are higher in older Veterans with PTSD symptoms. These findings underscore the importance for clinical providers to evaluate trauma history and PTSD symptoms in older Veterans reporting pain symptoms.

Dorsal Root Entry Zone Lesioning Following Unresponsive Spinal Cord Stimulation for Post-Traumatic Neuropathic Pain

Spinal cord stimulation (SCS) and dorsal root entry zone (DREZ) lesioning are important therapeutic options for intractable post-traumatic neuropathic pain (PNP). However, surgical choice is controversial due to the need to maximize pain relief and reduce complications. This study aims to retrospectively analyze the effect and complications of DREZ lesioning for patients with PNP who were unresponsive to SCS and provide a surgical reference. Demographic data and surgical characteristics of patients with PNP who underwent DREZ lesioning after an unresponsive SCS were reviewed. Long-term outcomes including numeric rating scale, global impression of change, and long-term complications were assessed. Kaplan-Meier analysis was used to evaluate pain-free survival. Of 19 patients with PNP, 8 had brachial plexus injury (BPI), 7 had spinal cord injury, 2 had cauda equina injury, 1 had intercostal nerve injury, and 1 had lumbosacral plexus injury. All patients were unresponsive or had a recurrence of pain after SCS, with an average pain-relief rate of 9.3%. After DREZ lesioning, the mean numeric rating scale scores significantly decreased from 7.6 ± 1.5 to 1.8 ± 1.7, with an average pain-relief rate of 75.3%. Seven patients (36.8%) experienced worsened neurologic dysfunction at the last follow-up. Patients with BPI had a significantly better outcome than other pathologies (P < 0.001) after DREZ lesioning. DREZ lesioning is an effective alternative procedure to SCS for patients with PNP who have lost limb function. Particularly for those with BPI, DREZ lesioning has shown good efficacy and can be considered a preferred surgical option.

Magnetic Peripheral Nerve Stimulation (mPNS) for Chronic Pain.

To assess magnetic peripheral nerve stimulation (mPNS) for the treatment of chronic or chronic and intractable neuropathic pain with a retrospective review case series. Twenty-four patients with predominantly neuropathic post-traumatic or postoperative pain were treated as per protocol and followed for 3 months. Data were analyzed as an observational, one-armed, convenience sample. Graphical evidence backed up by a mixed model for repeated measures statistical analysis showed a highly significant reduction of pain at one month out from initial treatment with mPNS. At one month, there was a 3.8 average reduction in pre-pain scores using a visual analogue scale (VAS), and that relief was generally durable measured out to three months. Two-thirds of patients, deemed responders, showed an 87% reduction in pain. Opioid reduction was seen in 58.3% of responders as well. mPNS appears promising for the treatment of chronic or chronic and intractable neuropathic pain for many of the same indications as traditional electrical peripheral nerve stimulation (PNS). No invasive techniques or implants are needed for mPNS.

Factors determining the development of post-traumatic pain and post-traumatic osteoarthritis

Injuries cause a systemic neurohumoral and behavioral response of the body, aimed at restoring damaged tissues and correcting biomechanical disorders. However, in many cases, full-fledged repair is impossible – traumatic injury, inflammation that occurs against its background, and degenerative processes (fibrosis, neoangiogenesis, heterotopic ossification) lead to severe structural changes and a progressive decrease in functional ability. The most common complications of trauma include chronic post-traumatic pain and post-traumatic osteoarthritis (PTOA). These complications are interrelated – pain (accompanied by stiffness and dysfunction) that occurs in 10–50% of people who have suffered a joint injury may indicate the formation of early (pre-radiological) stages of PTOA. The development of typical structural changes in PTOA is observed 10–15 years after a knee injury (in &gt;30% of patients). PTOA of large joints is more aggressive, often accompanied by synovitis, and requires arthroplasty on average 10–15 years earlier than primary osteoarthritis. Early diagnosis of PTOA is based on the analysis of the dynamics of clinical manifestations (primarily post-traumatic pain), visualization of early changes in the structure of the joint (magnetic resonance imaging), as well as the study of the level of biomarkers of inflammation and osteochondral destruction. As additional risk factors for PTOA, genetic features are considered that determine the chronicity of inflammation, pain, and impaired repair of cartilage and bone tissue.

558. Early Life Adversity Increases Risk for Posttraumatic Chronic Pain Via Enduring Hippocampal Changes: Preliminary Evidence From the AURORA Cohort and a Reverse-Translated Rodent Model

558. Early Life Adversity Increases Risk for Posttraumatic Chronic Pain Via Enduring Hippocampal Changes: Preliminary Evidence From the AURORA Cohort and a Reverse-Translated Rodent Model

Pain management following dental trauma and surgical procedures.

Surgical procedures and post-traumatic management of dental patients require effective pain management during treatment, but being considerably more invasive than conservative treatments, pain management is required into the postoperative period. Clinical trials on pain intensity following dental surgical procedures (e.g., 3rd molar extraction, implant placement, periodontal, and endodontic surgery) have shown that pain is most intense approximately 5-6 h after completion of the procedure, reaching its peak levels during the first postoperative day. Greatest consumption of analgesics occurs during the first 48-72 h after 3rd molar extraction. For the management of perioperative pain associated with either conservative or surgical dental treatment, the local anesthetics articaine, lidocaine, mepivacaine, and prilocaine are preferred. These drugs, with a vasoconstrictor, provide a rapid onset and a duration of pulpal anesthesia adequate to complete most dental and surgical procedures painlessly. For management of post-traumatic and postsurgical pain, bupivacaine-administered by an appropriate nerve block-near the conclusion of a surgical procedure, can provide the patient with a pain-free period of up to 12 h. Nonsteroidal anti-inflammatory drugs represent the most effective drugs for the management of dental postsurgical pain. NSAIDs, as a group in therapeutic doses, have numbers needed to treat (NNTs) ranging from 2 to 3, while opioid analgesics do not approach those for NSAIDs. A protocol for management of pain following surgical procedures and traumatic injuries is discussed in this paper and includes preemptive NSAID; perioperative pain management; postoperative pain management-local anesthesia; postoperative pain management-analgesics; postoperative telephone call.

Gender Differences In Post-Traumatic Stress Disorder Severity, Pain Catastrophizing, Interference, And Intensity In Veterans: Baseline Findings From The Learning To Apply Mindfulness To Pain Study

Gender Differences In Post-Traumatic Stress Disorder Severity, Pain Catastrophizing, Interference, And Intensity In Veterans: Baseline Findings From The Learning To Apply Mindfulness To Pain Study

Traumatic Stress-Induced RNA Expression Signatures In Rats Reveal Insights Into Fkbp5-Mediated Posttraumatic Pain Development

Traumatic Stress-Induced RNA Expression Signatures In Rats Reveal Insights Into Fkbp5-Mediated Posttraumatic Pain Development

Is Presurgical Pain Intensity Related to Postoperative Recurrence of Post-Traumatic Trigeminal Neuropathic Pain?

Post-traumatic trigeminal neuropathic pain (PTTNp) is a challenging condition to treat, and equally as challenging is the identification of surgical outcome variables to guide treatment. The study purpose was to determine if preoperative pain intensity was related to postoperative recurrence of PTTNp. This retrospective cohort study assessed subjects with preoperative PTTNp of either the lingual or inferior alveolar nerves who underwent elective microneurosurgery at a single institution. Two cohorts were established as follows: No PTTNp at 6months (group 1); presence of PTTNp at 6months (group 2). The primary predictor variable was the preoperative visual analog scale (VAS) score. The primary outcome variable was PTTNp (recurrence or no recurrence at 6months). The demographic and injury characteristics of the groups were compared to assess whether they were similar using Wilcoxon rank analysis. Two-tailed Student's t-test was performed to analyze the difference in preoperative mean VAS scores. Multivariate multiple linear regression models were used to determine the association between the covariates on the outcomes of the primary predictor variable and the primary outcome variable. A P value of <.05 was considered statistically significant. Forty-eight patients were included in the final analysis. There were 20 patients with no pain at 6months and 28 with recurrence at 6months following surgery. There was a significant difference in mean preoperative pain intensity between the two groups (P value .04). The mean preoperative VAS score in group 1 was 6.31 (standard deviation, 2.65), while the mean preoperative VAS score in group 2 was 7.75 (standard deviation, 1.95). Regression analysis showed that one covariate, the type of nerve injured, explained some variability of preoperative VAS score, but by only 16% (P value .005). Regression analysis also showed that two covariates, Sunderland classification and time to surgery, explained some of the variability of PTTNp at 6months, by approximately 30% (P value .001). This study showed that presurgical pain intensity level was related to postoperative recurrence in the surgical treatment of PTTNp. In patients with recurrence, the preoperative pain intensity was higher. Other factors, including time interval from injury to surgery, were also related to recurrence.

Pregabalin in Patients with Post-Traumatic Peripheral Neuropathic Pain: A Meta-Analysis of Randomized Controlled Trials.

To investigate the safety and efficacy of pregabalin versus placebo in post-traumatic peripheral neuropathic pain (PTNP). PubMed, Cochrane Library, Web of Science, and Google Scholar were searched for relevant evidence up to January 2022. The Cochran tool was used to assess the quality of randomized clinical trials (RCTs). Data analysis was performed using Comprehensive Meta-Analysis software. Three RCTs involving 821 patients were included in the meta-analysis. A significant difference was observed between pregabalin and placebo in terms of the pain score (the standardized mean difference [SMD] = -0.481, 95% CI: -0.75 to 0.20, P=0.04) and sleep interference (MD= -0.481, 95% CI: -0.75 to 0.20, P=0.00). There was also a significant difference between pregabalin and placebo regarding somnolence (risk ratio [RR] = 2.78; 95% CI: 1.64 to 4.71, P=0.00), dizziness (RR=4.13; 95% CI: 2.71 to 6.28, P=0.00), and disturbance in attention (RR: 2.97; 95% CI: 1.02 to 8.65, P=0.04). However, no significant difference was observed between pregabalin and placebo in terms of headache (RR=1.20; 95% CI: 0.70 to 2.06, P=0.50), fatigue (RR=1.42; 95% CI: 0.82 to 2.47, P=0.20), nausea (RR=1.52; 95% CI: 0.88 to 2.62, P=0.13), constipation (RR=1.84; 95% CI: 0.78 to 4.29, P=0.15), and discontinuation (RR=1.52; 95% CI: 0.45 to 5.06, P=0.49). Compared with placebo, pregabalin showed better efficacy in reducing PTNP and improving sleep interference. However, it was associated with higher adverse events. Further RCTs is needed to confirm these findings.

Pain neuroscience education improves post-traumatic stress disorder, disability, and pain self-efficacy in veterans and service members with chronic low back pain: Preliminary results from a randomized controlled trial with 12-month follow-up

ABSTRACT Post-traumatic stress disorder (PTSD) and chronic low back pain (CLBP) are frequently co-morbid. Some research suggests that PTSD and CLBP may share common neurobiological mechanisms related to stress. Traditional biomedical education may be ineffective for PTSD and CLBP, especially when co-morbid. The purpose of this study is to determine if pain neuroscience education (PNE) is more effective than traditional education in reducing PTSD, disability, pain, and maladaptive beliefs in patients with CLBP. Participants with CLBP and possible PTSD/PTSD-symptoms were recruited for this study. Participants were randomly allocated to a PNE group or a traditional education group. The intervention included 30 minutes of education followed by a standardized exercise program once a week for 4-weeks with a 4 and 8-week follow-up and healthcare utilization assessed at 12-months. Forty-eight participants consented for this research study with 39 allocated to treatment (PNE n = 18, traditional n = 21). PNE participants were more likely to achieve a clinically meaningful reduction in PTSD symptoms and disability at short-term follow-up. At 12-months, the PNE group utilized healthcare with 76% lower costs. In participants with CLBP, PNE may reduce hypervigilance toward pain and improve PTSD symptoms. Participants who received PNE were more confident body-tissues were safe to exercise. These beliefs about pain could contribute to a decrease in perceived disability and healthcare consumption for CLBP.

CpG Methylation Levels in HPA Axis Genes Predict Chronic Pain Outcomes Following Trauma Exposure

Chronic post-traumatic musculoskeletal pain (CPTP) is a common outcome of traumatic stress exposure. Biological factors that influence the development of CPTP are poorly understood, though current evidence indicates that the hypothalamic-pituitary-adrenal (HPA) axis plays a critical role in its development. Little is known about molecular mechanisms underlying this association, including epigenetic mechanisms. Here, we assessed whether peritraumatic DNA methylation levels at 248 5′—C—phosphate—G—3′ (CpG) sites in HPA axis genes (FKBP5, NR3C1, CRH, CRHR1, CRHR2, CRHBP, POMC) predict CPTP and whether identified CPTP-associated methylation levels influence expression of those genes. Using participant samples and data collected from trauma survivors enrolled into longitudinal cohort studies (n = 290), we used linear mixed modeling to assess the relationship between peritraumatic blood-based CpG methylation levels and CPTP. A total of 66 (27%) of the 248 CpG sites assessed in these models statistically significantly predicted CPTP, with the three most significantly associated CpG sites originating from the POMC gene region (ie, cg22900229 [β = .124, P < .001], cg16302441 [β = .443, P < .001], cg01926269 [β = .130, P < .001]). Among the genes analyzed, both POMC (z = 2.36, P = .018) and CRHBP (z = 4.89, P < .001) were enriched in CpG sites significantly associated with CPTP. Further, POMC expression was inversely correlated with methylation levels in a CPTP-dependent manner (6-months NRS<4: r = -.59, P < .001; 6-months NRS ≥ 4: r = -.18, P = .2312). Our results suggest that methylation of HPA axis genes including POMC and CRHBP predict risk for and may contribute to vulnerability to CPTP. PerspectivePeritraumatic blood levels of CpG methylation sites in HPA axis genes, particularly CpG sites in the POMC gene, predict CPTP development. This data substantially advances our understanding of epigenetic predictors and potential mediators of CPTP, a highly common, morbid, and hard-to-treat form of chronic pain.

Pain flashbacks: The role of intrusive pain symptoms in posttraumatic chronic pain

IntroductionFindings demonstrate the high comorbidity of posttraumatic stress disorder (PTSD) and chronic pain following exposure to trauma. In exposure to child abuse (CA) in particular, findings imply that CA survivors are at a higher risk of suffering from chronic pain. However, the underlying mechanisms of these processes are yet to be uncovered.ObjectivesThis study examined a new mechanism pertaining to the potential role of intrusive pain flashbacks for explaining the link between CA, C/PTSD, and chronic pain following interpersonal trauma.MethodsA community sample of 430 women (Sample A), and a sample of 164 women who were exposed to CA (Sample B) completed questionnaires assessing pain flashbacks, CA, C/PTSD symptoms, the experience of pain during the trauma, and chronic pain.ResultsThe findings showed that 8.9% of Sample A (N = 36), and 23.1% of Sample B (N = 37) reported experiencing pain flashbacks. In both samples, participants who experienced pain flashbacks reported more severe C/PTSD (p&lt;0.001), compared to participants who experienced flashbacks without pain and those who did not experience pain flashbacks. Participants who experienced pain flashbacks reported more pain during CA (p = 0.001), which corresponded with the pain flashbacks areas (Figure 1). Finally, pain flashbacks were correlated with a higher risk of suffering from chronic pain in Sample B (p=0.002).Image:ConclusionsThe findings of this study reveal that pain flashbacks are associated with more rampant CA and are linked to greater psychopathology. The findings call for further investigation of the role of pain flashbacks in explaining the link between exposure to trauma, C/PTSD and later chronic pain.Disclosure of InterestNone Declared

외상의 질곡에서 그녀들은 어떻게 성장해 왔는가? : 일본군 ‘위안부’ 피해 여성 노인의 삶의 경험

이 연구의 목적은 일본군 ‘위안부’ 피해 여성 노인이 피해 이후 삶에서 외상 후 성장의 주요 의미를 드러내줌으로써, 국내에 소수 생존해 있는 이 여성 노인들의 사회적 지원이 어떻게 가능할 것인지에 대한 실천적 시사점을 얻는데 있다. 이를 위해 이 연구는 일본군 ‘위안부’ 피해 여성 노인 5명의 삶의 영역을 Elo와 Kygἅs(2008)가 제시한 질적 내용분석 단계에 따라 분석하였다. 분석 결과, 일본군 ‘위안부’ 피해 여성 노인의 삶의 과정은 2가지 영역으로 구분해 볼 수 있었다. 그 영역은 ‘일본군 ‘위안부’로부터 벗어난 삶’, ‘인생 말년에 시작한 여성인권가로서의 삶’이다. 이를 통해, ‘실패한 결혼생활’, ‘먹고 살기에 급급했던 인생’, ‘살 이유가 된 소소한 행복도 존재’, ‘수십 년이 지나서야 털어놓은 엄청난 비밀’, ‘내가 부끄러운 존재가 아니라는 자각’, ‘말년이 되어서야 들어선 치유의 길’, ‘세계 여성 인권보호에 앞장서는 활동가의 삶’, ‘의로운 기부자의 삶’, ‘후세대와의 교류와 공감’, ‘말년에 이루어낸 인생 보람’, ‘수십 년의 세월이 흘러도 반복되는 트라우마의 상흔’, ‘해야만될 내 인생의 숙업’이란 총 12가지 하위 주제를 도출하였다. 위와 같은 연구결과를 바탕으로, 일본군 ‘위안부’ 피해 여성 노인의 외상 후 성장을 사회적으로 지원할 수 있는 몇가지 논의점을 제언하였다.