Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA Atlanta VA Medical Center, Atlanta, GA, USA Howard Hughes Medical Institute, Chevy Chase, MD, USA Yerkes National Primate Research Center, Atlanta, GA, USA.
Pain. 2011 Oct;152(10):2233-2240. doi: 10.1016/j.pain.2011.04.019. Epub 2011 Jun 12.
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.
疼痛综合征和创伤相关综合征的合并症已被证明很高。然而，特别是在平民医疗人群中，创伤相关障碍（如创伤后应激障碍（PTSD））对慢性疼痛和疼痛药物使用的作用的数据有限。我们分析了初级保健和妇产科候诊室的 647 名普通医院患者的创伤和 PTSD 相关应激障碍经历。发现 PTSD 症状与疼痛评分（r=.282，P<0.001）和与疼痛相关的功能障碍（r=0.303，P<0.001）显著正相关。当前 PTSD 诊断的患者主观疼痛和与疼痛相关的功能障碍评分明显高于无 PTSD 的患者。此外，与没有 PTSD 诊断的患者相比，当前诊断为 PTSD 的患者更有可能使用阿片类镇痛药来控制疼痛（χ(2)=8.98，P=0.011）。在分析单独的 PTSD 症状亚群（再体验、回避和警觉性增高）时，所有症状群都与疼痛和与疼痛相关的功能障碍评分显著相关，但只有回避症状群与先前使用阿片类止痛药显著相关。我们得出结论，创伤后应激障碍和创伤相关障碍在贫困医疗人群中很常见，应该在疼痛综合征患者中检查这些障碍的存在。此外，这些数据表明，创伤后应激障碍和疼痛可能共享易感性途径，包括内源性阿片神经递质系统。
