PTSD Symptoms and Patient-Related Outcomes in Chronic Pain

A woman in pain holding her neck
A woman in pain holding her neck
Patients with chronic pain and ≥1 posttraumatic stress disorder symptom, particularly numbness or detachment, have poor pain-related outcomes.

Patients with chronic pain and ≥1 posttraumatic stress disorder (PTSD) symptom, particularly numbness or detachment, have poor pain-related outcomes, according to a study published in the Journal of Pain.

The investigators assessed the relationship between 4 pain-related outcomes (pain intensity and interference, function, mood, quality of life, and substance abuse risk) and the type and number of PTSD symptoms in 4402 patients with chronic pain.

Patients were assessed using the PainTracker™ tool: pain intensity was assessed with the 0 to 10 Numeric Rating Scale, and pain interference with a 0 to 10 scale; the presence of PTSD symptoms was assessed with the 4-item Primary Care-PTSD Screen instrument that evaluates intrusion, avoidance, hyperarousal, and numbness or detachment.

Function was assessed with the Owestry Disability Index, and quality of life and mood with the Owestry Disability Index, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 tool, and the Patient Reported Outcome Measurement Information System Global Health Short Form questionnaire.

An increase in the number of reported PTSD symptoms was associated with increases in pain intensity and interference, risk for opioid misuse, depressive symptoms, severity of anxiety, as well as reduced health-related quality of life (P <.001 for all). Participants who reported ≥1 PTSD symptom had lower health-related quality of life, increased risk for opioid misuse, higher incidence of depression and anxiety symptoms, and greater pain interference compared with patients who reported no PTSD symptoms (P <.05). Numbness/detachment was associated with worse pain outcomes in this cohort, with the strongest association being with pain intensity.

Researchers were unable to determine causal relationships between PTSD symptoms and chronic pain, primarily due to the cross-sectional nature of the analysis. Also, investigators were unable to determine whether participants’ pain was due to or preceded a traumatic event, as time since the event and chronic pain duration were not recorded.

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“Numbness or detachment as a result of trauma exposure appears to be the PTSD symptom most strongly associated with pain-related outcomes,” concluded the researchers, adding “This numbness and detachment warrants further investigation and may comprise an important target for interventions that improve both PTSD symptoms and pain.”

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Langford DJ, Theodore BR, Balsiger D, et al. Number and type of post-traumatic stress disorder (PTSD) symptom domains are associated with patient-reported outcomes in patients with chronic pain [published online January 4, 2018]. J Pain. doi:10.1016/j.jpain.2017.12.262