Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, OR, USA Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA Portland Center for the Study of Chronic, Comorbid Medical and Psychiatric Disorders, Portland VA Medical Center, Portland, OR, USA Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
Pain. 2013 Apr;154(4):609-616. doi: 10.1016/j.pain.2013.01.001. Epub 2013 Jan 11.
People with chronic pain and comorbid posttraumatic stress disorder (PTSD) report more severe pain and poorer quality of life than those with chronic pain alone. This study evaluated the extent to which associations between PTSD and chronic pain interference and severity are mediated by pain-related coping strategies and depressive symptoms. Veterans with chronic pain were divided into 2 groups, those with (n=65) and those without (n=136) concurrent PTSD. All participants completed measures of pain severity, interference, emotional functioning, and coping strategies. Those with current PTSD reported significantly greater pain severity and pain interference, had more symptoms of depression, and were more likely to meet diagnostic criteria for a current alcohol or substance use disorder (all p-values <.01). Participants with PTSD reported more use of several coping strategies, including guarding, resting, relaxation, exercise/stretching, and coping self-statements. Illness-focused pain coping (i.e., guarding, resting, and asking for assistance) and depressive symptoms jointly mediated the relationship between PTSD and both pain interference (total indirect effect=0.194, p<.001) and pain severity (total indirect effect=0.153, p=.004). Illness-focused pain coping also evidenced specific mediating effects, independent of depression. In summary, specific pain coping strategies and depressive symptoms partially mediated the relationship between PTSD and both pain interference and severity. Future research should examine whether changes in types of coping strategies after targeted treatments predict improvements in pain-related function for chronic pain patients with concurrent PTSD.
患有慢性疼痛和共病创伤后应激障碍（PTSD）的人报告的疼痛比仅患有慢性疼痛的人更严重，生活质量更差。本研究评估了 PTSD 与慢性疼痛干扰和严重程度之间的关联在多大程度上受到与疼痛相关的应对策略和抑郁症状的中介。患有慢性疼痛的退伍军人分为两组，一组（n=65）和一组（n=136）同时患有 PTSD。所有参与者都完成了疼痛严重程度、干扰、情绪功能和应对策略的测量。目前患有 PTSD 的人报告的疼痛严重程度和疼痛干扰明显更大，有更多的抑郁症状，并且更有可能符合当前酒精或物质使用障碍的诊断标准（所有 p 值均<.01）。患有 PTSD 的参与者报告使用了几种应对策略，包括保护、休息、放松、运动/伸展和应对自我陈述。以疾病为中心的疼痛应对（即保护、休息和寻求帮助）和抑郁症状共同介导了 PTSD 与疼痛干扰（总间接效应=0.194，p<.001）和疼痛严重程度（总间接效应=0.153，p=.004）之间的关系。以疾病为中心的疼痛应对也具有特定的中介作用，与抑郁无关。总之，特定的疼痛应对策略和抑郁症状部分介导了 PTSD 与疼痛干扰和严重程度之间的关系。未来的研究应该检查针对特定治疗后应对策略类型的变化是否可以预测同时患有 PTSD 的慢性疼痛患者疼痛相关功能的改善。
