Åkerblom Sophia, Perrin Sean, Rivano Fischer Marcelo, McCracken Lance M
Department of Pain Rehabilitation, Skåne University Hospital.
Departments of Psychology.
Clin J Pain. 2018 Jun;34(6):487-496. doi: 10.1097/AJP.0000000000000561.
The symptoms of posttraumatic stress disorder (PTSD) and chronic pain are thought to interact to increase the severity and impact of both conditions, but the mechanisms by which they interact remain unclear. This study examines the relationship between PTSD and chronic pain and whether indices of Psychological Flexibility mediate the relationship between these 2 conditions.
Standardized self-report measures of PTSD, pain severity, pain interference, depression, and psychological flexibility (pain-related acceptance, committed action, cognitive fusion, and values-based action) were obtained from 315 people seeking treatment for chronic pain who also reported at least 1 traumatic experience.
People seeking treatment for chronic pain and reporting symptoms consistent with a current diagnosis of PTSD had significantly higher levels of pain severity, pain interference, depression, and cognitive fusion and lower levels of pain-related acceptance and committed action than those reporting symptoms below the diagnostic threshold for PTSD. Pain-related acceptance, committed action, cognitive fusion, and depression mediated the relationship between PTSD and pain severity/interference, with pain-related acceptance being the strongest mediator from the Psychological Flexibility model.
Processes from the Psychological Flexibility model were identified as mediators of the relationship between PTSD and chronic pain in people seeking treatment for chronic pain. The Psychological Flexibility model may be useful as an overarching model to help understand the relationship between PTSD and chronic pain. It is possible that targeting pain-related acceptance, committed action, and cognitive fusion (among other processes) in the treatment of chronic pain may produce corresponding improvements in comorbid symptoms of PTSD when these are present and may reduce impacts of PTSD on outcomes of chronic pain. Conversely, targeting of these processes in the treatment of PTSD may produce similar improvements for symptoms of chronic pain. Further research to evaluate these possibilities is needed.
创伤后应激障碍（PTSD）症状与慢性疼痛被认为相互作用，会加重这两种病症的严重程度及影响，但二者相互作用的机制尚不清楚。本研究考察了PTSD与慢性疼痛之间的关系，以及心理灵活性指标是否在这两种病症之间的关系中起中介作用。
从315名寻求慢性疼痛治疗且报告至少有1次创伤经历的患者那里获取了PTSD、疼痛严重程度、疼痛干扰、抑郁及心理灵活性（与疼痛相关的接纳、坚定行动、认知融合及基于价值观的行动）的标准化自评量表。
寻求慢性疼痛治疗且报告的症状符合当前PTSD诊断标准的患者，其疼痛严重程度、疼痛干扰、抑郁及认知融合水平显著高于报告的症状低于PTSD诊断阈值的患者，而与疼痛相关的接纳和坚定行动水平则较低。与疼痛相关的接纳、坚定行动、认知融合及抑郁在PTSD与疼痛严重程度/干扰之间的关系中起中介作用，其中与疼痛相关的接纳是心理灵活性模型中最强的中介因素。
心理灵活性模型中的过程被确定为寻求慢性疼痛治疗的患者中PTSD与慢性疼痛之间关系的中介因素。心理灵活性模型可能有助于作为一个总体模型来理解PTSD与慢性疼痛之间的关系。在慢性疼痛治疗中针对与疼痛相关的接纳、坚定行动和认知融合（以及其他过程），可能会在存在PTSD共病症状时相应改善这些症状，并可能减少PTSD对慢性疼痛治疗结果的影响。反之，在PTSD治疗中针对这些过程，可能会对慢性疼痛症状产生类似的改善。需要进一步研究来评估这些可能性。
